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COMBATING TERRORISM: FEDERAL RESPONSE TO

A BIOLOGICAL WEAPONS ATTACK

HEARING

BEFORE THE

SUBCOMMITTEE ON NATIONAL SECURITY,

VETERANS AFFAIRS AND INTERNATIONAL

RELATIONS

OF THE

COMMITTEE ON

GOVERNMENT REFORM

HOUSE OF REPRESENTATIVES

ONE HUNDRED SEVENTH CONGRESS

FIRST SESSION

JULY 23, 2001

Serial No. 107–99

Printed for the use of the Committee on Government Reform

(

Available via the World Wide Web: http://www.gpo.gov/congress/house

http://www.house.gov/reform

(II)

COMMITTEE ON GOVERNMENT REFORM

DAN BURTON, Indiana, Chairman

BENJAMIN A. GILMAN, New York

CONSTANCE A. MORELLA, Maryland

CHRISTOPHER SHAYS, Connecticut

ILEANA ROS-LEHTINEN, Florida

JOHN M. MCHUGH, New York

STEPHEN HORN, California

JOHN L. MICA, Florida

THOMAS M. DAVIS, Virginia

MARK E. SOUDER, Indiana

JOE SCARBOROUGH, Florida

STEVEN C. LATOURETTE, Ohio

BOB BARR, Georgia

DAN MILLER, Florida

DOUG OSE, California

RON LEWIS, Kentucky

JO ANN DAVIS, Virginia

TODD RUSSELL PLATTS, Pennsylvania

DAVE WELDON, Florida

CHRIS CANNON, Utah

ADAM H. PUTNAM, Florida

C.L. ‘‘BUTCH’’ OTTER, Idaho

EDWARD L. SCHROCK, Virginia

JOHN J. DUNCAN, JR., Tennessee

HENRY A. WAXMAN, California

TOM LANTOS, California

MAJOR R. OWENS, New York

EDOLPHUS TOWNS, New York

PAUL E. KANJORSKI, Pennsylvania

PATSY T. MINK, Hawaii

CAROLYN B. MALONEY, New York

ELEANOR HOLMES NORTON, Washington,

DC

ELIJAH E. CUMMINGS, Maryland

DENNIS J. KUCINICH, Ohio

ROD R. BLAGOJEVICH, Illinois

DANNY K. DAVIS, Illinois

JOHN F. TIERNEY, Massachusetts

JIM TURNER, Texas

THOMAS H. ALLEN, Maine

JANICE D. SCHAKOWSKY, Illinois

WM. LACY CLAY, Missouri

DIANE E. WATSON, California

——— ———

———

BERNARD SANDERS, Vermont

(Independent)

KEVIN BINGER, Staff Director

DANIEL R. MOLL, Deputy Staff Director

JAMES C. WILSON, Chief Counsel

ROBERT A. BRIGGS, Chief Clerk

PHIL SCHILIRO, Minority Staff Director

SUBCOMMITTEE ON NATIONAL SECURITY, VETERANS AFFAIRS AND INTERNATIONAL

RELATIONS

CHRISTOPHER SHAYS, Connecticut, Chairman

ADAM H. PUTNAM, Florida

BENJAMIN A. GILMAN, New York

ILEANA ROS-LEHTINEN, Florida

JOHN M. MCHUGH, New York

STEVEN C. LATOURETTE, Ohio

RON LEWIS, Kentucky

TODD RUSSELL PLATTS, Pennsylvania

DAVE WELDON, Florida

C.L. ‘‘BUTCH’’ OTTER, Idaho

EDWARD L. SCHROCK, Virginia

DENNIS J. KUCINICH, Ohio

BERNARD SANDERS, Vermont

THOMAS H. ALLEN, Maine

TOM LANTOS, California

JOHN F. TIERNEY, Massachusetts

JANICE D. SCHAKOWSKY, Illinois

WM. LACY CLAY, Missouri

——— ———

——— ———

EX OFFICIO

DAN BURTON, Indiana HENRY A. WAXMAN, California

LAWRENCE J. HALLORAN, Staff Director and Counsel

R. NICHOLAS PALARINO, Senior Policy Advisor

JASON CHUNG, Clerk

DAVID RAPALLO, Minority Counsel

(III)

C O N T E N T S

Page

Hearing held on July 23, 2001 ............................................................................... 1

Statement of:

Hamre, Dr. John, president and chief executive officer, Center for Strategic and International Studies; Frank Keating, Governor of Oklahoma;

Hon. Sam Nunn, chairman and chief executive officer, Nuclear Threat

Initiative, and former Senator; Dr. Margaret Hamburg, vice president,

Biological Programs for the Nuclear Threat Initiative; Jerome Hauer,

managing director, Kroll Associates; and Dr. D.A. Henderson, director,

Johns Hopkins Center for Bioterrorism Prevention .................................. 3

Harrison, Major General Ronald O., the adjutant general of Florida;

Major General William A. Cugno, the adjutant general of Connecticut,

accompanied by Major General Fred Reese; Dr. James Hughes, Director, National Center for Infectious Diseases, Centers for Disease Control and Prevention, accompanied by Dr. James LeDuc, Acting Director,

Division of Viral and Rickettsial Diseases, Director, National Center

for Infectious Diseases; Dr. Patricia Quinlisk, medical director and

State epidemiologist, Iowa Department of Public Health and former

president, Council and Territorial Epidemiologists; and Dr. Jeffrey

Duchin, Chief, Communicable Disease Control, Epidemiology and Immunization Section, Public Health, Seattle and King County, WA .......... 86

Letters, statements, etc., submitted for the record by:

Cugno, Major General William A., the adjutant general of Connecticut,

prepared statement of ................................................................................... 102

Duchin, Dr. Jeffrey, Chief, Communicable Disease Control, Epidemiology

and Immunization Section, Public Health, Seattle and King County,

WA, prepared statement of .......................................................................... 137

Hamburg, Dr. Margaret, vice president, Biological Programs for the Nuclear Threat Initiative, prepared statement of ........................................... 62

Hamre, Dr. John, president and chief executive officer, Center for Strategic and International Studies, prepared statement of ............................... 33

Harrison, Major General Ronald O., the adjutant general of Florida,

prepared statement of ................................................................................... 90

Hauer, Jerome, managing director, Kroll Associates, prepared statement

of ..................................................................................................................... 56

Hughes, Dr. James, Director, National Center for Infectious Diseases,

Centers for Disease Control and Prevention, prepared statement of ....... 110

Keating, Frank, Governor of Oklahoma, prepared statement of .................. 16

Nunn, Hon. Sam, chairman and chief executive officer, Nuclear Threat

Initiative, and former Senator, prepared statement of .............................. 26

Quinlisk, Dr. Patricia, medical director and State epidemiologist, Iowa

Department of Public Health and former president, Council and Territorial Epidemiologists, prepared statement of ............................................ 127

Shays, Hon. Christopher, a Representative in Congress from the State

of Connecticut, publication entitled, ‘‘National Security Roles for the

National Guard’’ ............................................................................................ 146

(1)

COMBATING TERRORISM: FEDERAL RESPONSE TO A BIOLOGICAL WEAPONS ATTACK

MONDAY, JULY 23, 2001

HOUSE OF REPRESENTATIVES,

SUBCOMMITTEE ON NATIONAL SECURITY, VETERANS

AFFAIRS AND INTERNATIONAL RELATIONS,

COMMITTEE ON GOVERNMENT REFORM,

Washington, DC.

The subcommittee met, pursuant to notice, at 2:35 p.m., in room

2154, Rayburn House Office Building, Hon. Christopher Shays

(chairman of the subcommittee) presiding.

Present: Representatives Shays, Putnam, Gilman, Schrock,

Kucinich, and Tierney.

Staff present: Lawrence Halloran, staff director/counsel; R. Nicholas Palarino, senior policy analyst; Robert A. Newman and Thomas Costa, professional staff members; Jason Chung, clerk; David

Rapallo, minority counsel; and Ellen Rayner, minority chief clerk.

Mr. SHAYS. I would like to call this hearing to order and welcome

our witnesses and guests.

A word of caution: Some of what we are about to see and hear

is not for the squeamish, but the frightening little sickening impact

of a large scale biological weapons attack on the United States has

to be confronted on its own terms. Better to be scared by the improbable possibility than to be unprepared for the catastrophic reality.

The focus of our hearing today is a recent terrorism response exercise ominously named Dark Winter, during which the unimaginable had to be imagined, a multi-site smallpox attack on an

unvaccinated American populace.

The scenario called upon those playing the President, the National Security Council, and State officials to deal with the crippling consequences of what quickly became a massive public health

and national security crisis.

The lessons of Dark Winter add to the growing body of strategic

and tactical information needed to support coordinated

counterterrorism policies and programs. Coming to grips with the

needs of first responders, the role of the Governors, use of the National Guard, and the thresholds for Federal intervention in realistic exercises vastly increases our chances of responding effectively

when the unthinkable but some say inevitable outbreak is upon us.

The costs of an uncoordinated, ineffective response will be paid in

human lives, civil disorder, loss of civil liberties and economic disVerDate 11-MAY-2000 10:00 Sep 25, 2002 Jkt 000000 PO 00000 Frm 00005 Fmt 6633 Sfmt 6633 C:\DOCS\81593.TXT HGOVREF1 PsN: HGOVREF1
2

ruption that could undermine both national security and even national sovereignty.

If there is a ray of hope shining through Dark Winter, it is

sparked by this irony. Improving the public health infrastructure

against a man-made biological assault today better prepares us to

face natural disease outbreaks every day. Just as biotechnologies

can be used to produce both lifesaving therapies and deadly pathogens, public health capabilities are likewise dual use, enhancing

our protection against smallpox attacks by a terrorist and an influenza epidemic produced by mother nature.

Let me welcome and thank our most distinguished witnesses this

afternoon. Our first panel consists of key partners in the Dark

Winter exercise. We look forward to testimony from Oklahoma Governor Frank Keating, former Senator Sam Nunn, and their colleagues describing the critical path of decisionmaking during a

spreading public health and public safety crisis.

Witnesses on our second panel will address the important role of

the National Guard and public health personnel in a bilateralism

response.

Like politics, all disasters are local, at least initially. State military units and public health professionals, among others, man the

first line of defense against the consequences of a biological attack.

Their perspective is important, and we appreciate the time, talent

and dedication they bring to our discussion this afternoon.

I would like to recognize our first panel, the Honorable Frank

Keating, Governor of Oklahoma; the Honorable Sam Nunn, chairman and chief executive officer, Nuclear Threat Initiative, and

former Senator; Dr. John Hamre, president and chief executive officer, Center for Strategic International Studies; Dr. Margaret Hamburg, vice-president, biological programs for the Nuclear Threat

Initiative; and Mr. Jerome Hauer, managing director, Kroll Associates.

I think, as you know, it is our practice to administer the oath in

this committee, and I just invite you all to stand and raise your

right hands.

[Witnesses sworn.]

Mr. SHAYS. Thank you very much. Now, I was thinking, we have

sworn in everyone in my entire 7 years as chairman except one

person, Senator Byrd. I chickened out, Senator Nunn, when Senator Byrd came in. But I realize that it is both an honor to testify,

I think, on this important issue and others, and I appreciate your

being willing to be sworn in.

At this time, we will start with you, Governor Keating, and

then—I am sorry, we have—you are in charge.

3

STATEMENTS OF DR. JOHN HAMRE, PRESIDENT AND CHIEF

EXECUTIVE OFFICER, CENTER FOR STRATEGIC AND INTERNATIONAL STUDIES; FRANK KEATING, GOVERNOR OF OKLAHOMA; HON. SAM NUNN, CHAIRMAN AND CHIEF EXECUTIVE

OFFICER, NUCLEAR THREAT INITIATIVE, AND FORMER SENATOR; DR. MARGARET HAMBURG, VICE PRESIDENT, BIOLOGICAL PROGRAMS FOR THE NUCLEAR THREAT INITIATIVE; JEROME HAUER, MANAGING DIRECTOR, KROLL ASSOCIATES; AND DR. D.A. HENDERSON, DIRECTOR, JOHNS HOPKINS CENTER FOR BIOTERRORISM PREVENTION

Mr. HAMRE. No, I am not in charge. I am just trying to stay

ahead of this bunch. That is all I’m trying to do.

Mr. SHAYS. Well, as far as I am concerned, you have the floor,

so you are in charge.

Mr. HAMRE. Thank you. It is a real privilege. And my role here

today is really simply to summarize enough of the exercise so that

you feel you could sit in today back in the chair—when we met

about a month ago and what was going on in everybody’s head so

you can appreciate the very powerful message, and if I can ask us

to go the—— Mr. SHAYS. Now, I understand there may be some graphic display here.

Mr. HAMRE. Sir, there will be graphics as well as some video.

This will be shown on these side monitors.

Mr. SHAYS. I’m told that some of it is not pleasant.

Mr. HAMRE. It is not pleasant. Let me also emphasize, sir, this

is a simulation. This had frightening qualities of being real, as a

matter of fact too real. And because we have television cameras

here broadcasting, we want to tell everyone, this did not happen,

it was a simulation.

But, it had such realism, and we are going to try to show you

the sense of realism that came from that today.

Why don’t we go to the next chart, if I may, please.

Well, we are—if I could, while we are waiting. Let me just introduce and say that there were three institutions that collaborated

on this project, the Center for Strategic and International Studies,

the Johns Hopkins Center for Bioterrorism Prevention that Dr.

D.A. Henderson, who is sitting here—Dr. Henderson, you should

know as well, is one man that is probably more responsible for

eradicating smallpox than any other person in America. And he is

now——

Mr. SHAYS. Would you raise your hand, sir? You are the gentleman?

Mr. HAMRE. He is dedicating himself now to the protection of the

United States against these terrible diseases.

The other is the ANSER Corp. Dr. Ruth David is the president

and CEO, and she was instrumental in bringing together so much

of the resources, she and her remarkable staff. And we are ready

to go.

Let me say, Dark Winter was meant to be an exercise to see how

would the United States cope with a catastrophic event, in this

case a bioterrorism event. We thought that we were going to be

spending our time with the mechanisms of government. We ended

4

up spending our time saying, how do we save democracy in America? Because it is that serious, and it is that big.

Let’s go to the next chart, please. This is what we will cover

today. We will go briefly through just to say who are the participants and the goals of the exercise, and then we also want—quickly want to take you through the exercise itself so that you have a

chance to observe it.

We will then pull out some of the key observations, and all of my

colleagues here will be speaking to those along the way.

Next chart, please.

Mr. SHAYS. Dr. Hamre, may I just interrupt to welcome Mr.

Tierney, who is here.

Mr. TIERNEY. Sorry for the interruption.

Mr. SHAYS. Great to have you here. Would you just make your

first point again?

Mr. HAMRE. I said, Mr. Tierney, we were delighted to be invited

to be participants here. We thought that we were going to be getting together as a group. Everyone who was participating in this

exercise were former government officials. Everybody had—that

was the sitting at the National Security Council had really been

there before in one role or another.

And of course we had Governor Keating sitting as Governor

Keating in the exercise. And we thought that we were really going

to get together to talk about the mechanics of government. And

what we ended up doing is saying, how do we save democracy in

America if we ever have an episode like this that were to occur for

real.

Mr. SHAYS. I would also welcome Mr. Gilman as well. And I

think what I will do, since they have come before you jumped right

in, to give either an opportunity to have an opening statement, and

then we will get right to your testimony.

Do you have any statement?

Mr. TIERNEY. No. I am happy to hear the testimony. Thank you.

Mr. SHAYS. Mr. Gilman, do you have any statement?

Mr. GILMAN. Thank you, Mr. Chairman. I want to thank you for

conducting this hearing at this time. Today’s hearing to examine

our overall relationship between the Federal and State governments in trying to form a cohesive and effective response to a biological weapons attack is very timely.

For many years the possibility of a bioterrorist attack occurring

in our own Nation seemed absurd, something to be relegated to the

realm of science fiction. Sadly, events over the last few years, with

bombings occurring in New York, Oklahoma City, have transformed the bioterrorism debate from a question of if, to the seeming inevitably of when.

The task of developing an adequate, effective, overall strategy to

successfully counter any domestic act of bioterrorism has proven to

be a difficult challenge for Federal and State policymakers.

Our Nation is a highly mobile society with a system of government wherein power and responsibility are diffused between Federal, State and local authorities. Moreover, the American people

are accustomed to an unprecedented amount of personal freedom

not found in any other nation.

5

All of these factors make the quick containment of any biological

attack and effective subsequent quarantining of any affected individuals highly problematic. Indeed, primary results from the past

exercises, including one recently concluded, have not been very encouraging.

I look forward to the testimony that our panelists will be presenting, and particularly those who participated in the recently

held Dark Winter exercise. I am certain that their experience and

insight will prove useful to this committee as Congress works to try

to find a proper role in this emerging and vexing problem.

Once again, Mr. Chairman, thank you for your leadership on this

important topic.

Mr. SHAYS. Thank you both, gentlemen, for being here. Dr.

Hamre, let me just take care of—a quorum is present. I ask unanimous consent that all members of the subcommittee be permitted

to place an opening statement in the record, and without objection,

so ordered. And also ask further unanimous consent that all witnesses be permitted to include their written statements in the

record. Without objection, so ordered. And 3 days for both.

You now truly have the floor. Do you want us to dim the lights?

I am afraid to ask. I don’t know if we know how to do that.

Mr. HAMRE. I leave it up to your professional staff that has a better feel. I think that we can see it.

Mr. SHAYS. We’ll light it.

Mr. HAMRE. I also forgot to mention that this exercise, because

all of us are not-for-profit entities, was funded by two entities. It

is very important for me to say this. This was not paid for by a

contractor. This was not paid for by the Government. This was paid

for by two not-for-profit entities that are dedicating themselves to

helping protect America, the McCormick Tribune Foundation and

the Memorial Institute for the Prevention of Terrorism in Oklahoma City.

Mr. SHAYS. Not to confuse you, there is a screen in front of the

desk. So we are not looking at Governor Keating and Senator Nunn

while you are showing your presentation. It is right in front of you.

Mr. HAMRE. Yes, sir. OK. So now we will proceed, if we could,

to the next one.

These are the participants, and I won’t go through it here. Everybody that we had sitting there has been in the National Security

Council for real.

Next chart, please. And we also, to add additional realism to this

exercise, we actually brought in sitting journalists. They actually

sat there to watch and participate, because a fair amount of this

exercise dealt with how we would cope with a public campaign and

explain it to the American public.

Next chart, please.

These are the five goals that we had for the exercise. This is

what we were trying to do. We were trying to figure out what was

going to be the impact on national security of a biological attack.

We especially wanted to look at the implications for Federal and

State interactions, and this turned out to be one of the most important elements for us to learn. And we will bring some of this out

in the lessons learned later on. But I must tell you that there was

a major divide in this National Security Council between those who

6

are at the national level and those who understood the response at

the State level, and we should talk about that later.

We were especially looking at what does it take to make these

life or death decisions when we don’t have enough money for what

it really takes to do it, and coping with a scarcity of assets, and

especially vaccines, was a major dimension of the exercise. We tried

to deal with the issue of information, how do you communicate to

the American public at a time of extreme crisis, and then finally

to talking about the very tough ethical and moral issues that came

from this exercise.

Let’s go to the next chart. And I think this is going to get to you

to the beginning of this, the way that we experienced it.

[Video played.]

Mr. HAMRE. So when the National Security Council met this

evening, the first night of our exercise, they thought they were getting together to talk about a crisis that was emerging between the

United States and Iraq, because we have learned of this breaking

news of a potential smallpox attack.

The President called the National Security Council together. Fortunately, Governor Keating, who was in town anyway, joined us for

the exercise and of course for explaining his presence, he would

normally be at an NSC meeting, but he was there that evening.

Let’s go to the next chart, please. This is what happened on the

first day. This is what the NSC was learning that night. What we

were looking at—this is around December 9th—some two dozen patients were reporting into Oklahoma City hospitals with signs of

smallpox. It was quickly spreading around the town, and indeed

the Centers for Disease Control quickly confirmed that it was indeed smallpox.

Next chart, please. Smallpox was eradicated in the United States

in 1978—we have not had any evidence of it or at least in—in 1949

is when it was last in the United States, but it was eradicated 30

years ago. It is a very contagious disease and highly lethal; 30 percent of the people that get it will die. And once you get it, you simply have to ride it out. There is no real therapy for it. There is a

vaccine that you can take, but you must get the vaccine before you

have demonstrated symptoms. So it is a very tough problem to

work with.

Let’s go to the next chart, please. These are historical pictures

of smallpox. Smallpox was the leading cause of blindness in the

world before its eradication. It is a very ugly disease. This is, of

course, in the more advanced stages where smallpox, after the first

week or so, starts forming these pox. It is very ugly. It is at this

stage where it is highly contagious.

Next chart, please. The United States has approximately 12 million effective doses of vaccine that are available. It is possible to

administer the vaccine, but you must administer it before you demonstrate symptoms if it is going to be effective.

In this case, we thought we had 12 million doses, but as you will

see shortly, its exposure in this exercise was in communities where

there were more than 12 million people living.

The National Security Council, one of its initial challenges was

to decide how do we administer or strategically how do we allocate

these scarce numbers of doses to the American public?

7

Next chart, please. Here is what the National Security Council

knew at the time. Again it is very—I am trying to compress into

3 minutes what was taking 4 hours in discussion.

We clearly knew that smallpox was now being reported in three

States. It was reported in Oklahoma, in Atlanta and in Pennsylvania. It was presumed to be a deliberate release, because smallpox

is no longer natural in the environment, and so it was probably

caused, but we did not know how.

We did know that vaccination is a source of—is one of the tools,

but the other tool is isolation, trying to prevent the spread of the

disease. We also knew at the time that Iraqi forces were mobilizing. We did not know if these were related phenomena, if it was

at the same time being connected to the deployment in the Persian

Gulf.

We also did not have any smoking gun. We did not know who

caused it, and we had no idea where it came from. The other thing

we did not know, which was very crucial, is we had no idea how

extensive the attack was when it was unfolding.

So that first night, and we met on a Friday night, simulating the

first day of the exercise, we were really dealing with a lot of scientific information, very little insight into what to do about it, because we did not know where it had been spread and how extensive

the illness was already.

Next chart, please. These were the key issues that we were looking at that first night; you know, who controls the release of vaccine, how do you administer vaccine, who should be getting it? How

do you protect the first responders, because you need the first responders. Who is on the front line.

I can remember Senator Nunn saying, who is on the front line?

We had national security people saying we have to reserve doses

for the military, and we had State and local responders saying we

are the front line in this war. You have got to save us. You have

got to protect us first. So it was a major debate.

So this—let’s go to the next chart, please.

Now, we are going to show you a video from that first evening

as well.

[Video played.]

Mr. HAMRE. Through the exercise we were introducing videos

along the way to give some sense of realism to the evening. Now,

let me—OK. Let’s go the next chart if we could, please.

Here is what the Council decided on the first night. They decided

to try to accelerate the production of vaccines. There is ongoing

production, but emergency production would be required, and you

would need to waive a fair amount of regulation. If this happened

tomorrow, we would have to waive a fair amount of Federal regulation in order to get vaccines available on an expedited basis. That

even meant 6 to 8 weeks before we could get it.

We asked the Secretary of State to look for vaccines in other

countries. As it turns out, Russia had stocks, but there was a question about the safety and effectiveness of those stocks. So that was

an issue that the Council had to deal with.

The National Security Council ordered a ring strategy: Try to

find people that have been affected and then inoculate the people

that are in, as it were, a circle of acquaintances around the individVerDate 11-MAY-2000 10:00 Sep 25, 2002 Jkt 000000 PO 00000 Frm 00011 Fmt 6633 Sfmt 6633 C:\DOCS\81593.TXT HGOVREF1 PsN: HGOVREF1
8

ual who had been infected, one of the classic strategies for dealing

with a contagious disease.

We also directed—they directed that stocks be reserved for first

responders. Because if you are expecting to see health delivery and

security in infected areas, you have to reassure the people that

have to provide that security with a vaccine, or else they probably

aren’t going to do it, and you wouldn’t expect them to.

And finally they did reserve stocks for emergency break-outs, if

there were any further break-outs to occur.

Now, let’s go to the next chart. Here is what was not understood

at the time of that first evening, is that the game participants really never could see the full scope of the initial attack because they

didn’t know the facts yet. They weren’t yet in.

The—that indeed the infection rate was showing up first in the

cities where you had—where it was released, and they were released in three locations. Deliberate attack in Oklahoma, where it

was successful, and two botched attempts, one in Atlanta and one

in Philadelphia.

The participants did not know that at the time of the first

evening. So this was the scope of the infection that was not even

understood when people were having to make initial decisions. This

would be very typical of a bioterrorism incident.

Next chart, please.

The priority was given, you know, for vaccinations and isolation.

The stocks were very inadequate given the scope of the initial attack. Again, we didn’t realize that until the next day. But it was

one of those things that was unavoidable, and very difficult to get

situational awareness, to know what is really going on.

If there were one or two people that showed up in another State,

was that another source of an attack or was that just a pattern of

peoples’ normal commerce? Remember, this occurred in the scenario at the start of the shopping season before the Christmas holidays. It occurred in a shopping center. And that is why you don’t

know if it was a single point event or if was widespread——

Senator NUNN. Let me add a point or emphasize this, a point of

emphasis there. If we had known for certain or even speculated

with some reasonable basis that there was a certain area we could

have isolated, then obviously whatever you needed to do should

have been done right at the beginning: Isolating Oklahoma City,

isolating parts of Georgia, whatever.

But there was no clarity. We kept asking, do we know that it

hasn’t already spread all over? And the answer was, it could have

spread everywhere, because we didn’t know for 10 or 12 days that

it had even happened.

And those people that were in those shopping centers had dispersed in all directions. So when you start basically impinging on

their civil liberties and telling people they forcefully have to be

kept in their homes that may have been exposed, and when you

call out the National Guard to do that, and you at gunpoint put

your own citizens under, in effect, house arrest, and you don’t even

know that you are catching the right spot or that you’re dealing

with the right people, it is a terrible dilemma.

Because you know that your vaccine is going to give out, and you

know the only other strategy is isolation, but you don’t know who

9

to isolate. That is the horror of this situation. I just wanted to emphasize that as a point of emphasis.

Mr. GILMAN. Mr. Chairman, would you yield a moment?

How do you learn the extent of that kind of an outbreak? I address that to Senator Nunn.

Senator NUNN. I think that Dr. Hamburg would probably be the

best one to answer that. I think an answer that night in our exercise was we really could not.

Dr. HAMBURG. You would immediately begin as you identify

cases to put together the pieces that are common in the recent experience of the individuals who are sick and begin to do an outbreak investigation where you can trace back to what was the

source of exposure, the common source of exposure.

And in a case like this, although we obviously didn’t have the opportunity to play all of the elements fully, that kind of outbreak investigation would have been intensively going forward, requiring a

huge investment of trained personnel, epidemiologists to do that

medical detective work.

At the same time, since the suspicion was so high that this was

a bioterrorist event, we would also be having to have a law enforcement criminal investigation going on at the same time and trying

to trace back to the site of exposure, which would also be your best

chance of identifying the possible perpetrator as well.

Senator NUNN. One other point on this, right on that point. You

have got an inherent conflict between health and law enforcement.

And to the extent that they haven’t coordinated beforehand and

don’t know each other beforehand, before this occurrence took

place, you would have a horror show, because law enforcement has

one set of goals, health officials have another set of goals. The

President of the United States, and Governor Keating in this case

of Oklahoma, and the other Governors would have to make a

threshold decision which was more important.

I made the decision it was health rather than law enforcement.

But that drives an awful lot of decisions. If you don’t have any advanced coordination between health and law enforcement, you have

got a huge problem. And the same thing would be the case with

health and National Guard and health and the military. And the

same thing between the whole Federal, State, local governments.

So that is a real dilemma.

Mr. GILMAN. Thank you, Mr. Chairman.

Mr. SHAYS. Thank you.

Mr. HAMRE. Let’s go to the next chart there.

[Video played.]

Mr. HAMRE. Let me again, Mr. Chairman, say this, that this was

a simulation, for people that may just be joining us. This is not

real, but this was something that we were simulating in an exercise.

Mr. SHAYS. Still chilling.

Mr. HAMRE. Here is again what the National Security Council

knew. This was the beginning of the next morning. Basically we

advanced the clock. We were now at the 6th day in the exercise.

Here is what the National Security Council was confronting, that

they had—over 2,000 people had been infected. The medical care

system had been overwhelmed.

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You know, we have cut back medical care so that it is to the

least amount of excess capacity in peacetime as possible, because

we can’t afford it. And of course when you have a catastrophic

event like this, it overwhelms the medical care system very quickly

for all practical purposes. Vaccine is now gone, because you are trying to contain it in each location. It is now in over 20 States, we

are out of vaccine.

Still the Council does not know where it came from or how widespread it is. It is clear that it was probably deliberate, but it is unclear if this was terrorism or really an act of war.

Let’s go to the next chart, please.

[Video played.]

Mr. HAMRE. Next chart, please.

Let me emphasize that this was not a game where there was a

right answer or a wrong answer. I mean, this is a case where none

of us were experiencing anything that we had ever lived through

before. So the National Security Council was coping with very

stressful situations, so please don’t judge them as to the decisions

that they made. There is no right answer here, we are all learning.

At the time the participants came to realize that it’s now—that

vaccine was no longer going to be an effective solution. We were

out of it. And we now had to deal with the issues of how do you

constrain it by constraining peoples’ movement and behavior.

There was a major debate inside the National Security Council

at the time between the National Security side and the local response side as to whether or not we should Federalize the National

Guard.

Let me ask Governor Keating to jump and speak to the issue

from a Governor who is sitting there, what he was confronting

when we had the debate in Washington over whether we should

Federalize the Guard.

Governor KEATING. Well, I certainly wasn’t very happy about

what those pesky Texans did to my border. But the problem Senator Nunn said was the level of information that we had, and the

expectation of local decisionmaking and local response.

I might say that the one thing that we didn’t have, because that

is the nature of the beast, was information. The first question that

was asked by us was, what is smallpox? And what is the cure? And

are there vaccines? And what do we do?

Well, for me as a Governor hearing this information, suggested

by the President, that we encourage people to remain in their

homes, that we encourage little, if any, transit between population

centers, I made a decision to close the airports except for supplies

of medical equipment and personnel, also the roads except for supplies of medical equipment, personnel and food and other essential

items provided the truckers are vaccinated. That was an ad hoc decision on my part.

One of the generals at the table—this is why there was no script

whatsoever, Mr. Chairman, except the first comment that was

made right at the outset. Somebody said, what authority do you

have to do that? And I said, because I am the Governor of my

State. I am going to do it because this is how I think I should respond to a calamity such as this.

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The most important thing that we needed was information. And

obviously once that information was imparted, provided it is able

to be relied upon and it is firm and final, then suggestions from

the Federal family as to what assets and resources would be available.

In our Federal system, with such diffuse decisionmaking, that is

crucial. What are the facts? What is the answer? What are the resources that should—must be made available to address it?

And obviously the comity, the information that must exist between the Federal family and the State and local family was essential. I was basically the skunk at the garden party. I raised the

issues of the need for bottom-up responses as opposed to top-down

responses. And sometimes I won, sometimes I lost. But the President did an outstanding job of making sure that I won as many

times as I lost.

Senator NUNN. One added note on the Governor’s comment.

When the Texas Governor—we were told the Texas Governor had

nationalized the Texas Guard and blocked the border from Oklahoma. Well, obviously if other States around Oklahoma had done

the same thing, they would have been isolated, you couldn’t have

gotten food, water, whatever they might have needed in emergencies in there.

It had the possible result of being an absolute, total disaster. All

of my National Security Advisers, Secretary of the Defense, and the

whole team of National Security Advisers sitting around the table

advised me as President to nationalize the Texas Guard, thereby

overruling the Texas Governor.

That was a hard decision, but I decided not to do it. I decided

to get the Governor who happened to be there, but in case if he

hadn’t been there, I would have gotten someone else, or I might

have called myself to try to plead with the Texas Governor not to

do that, not to have that kind of force.

But I judged that if I tried to nationalize a Guard force that had

been mobilized by their Governor to protect the citizens of their

State, in their eyes, and to protect their own families, the worst of

all worlds might be that they basically wouldn’t respond to Federal

authority and then you would have had pure anarchy. And I felt

that the threshold decision had to be made that this had to be a

partnership, and we had to go to every length to try to convince

the Governor of Texas to cooperate.

So that was the way that one was playing out. And of course,

Governor Keating, I kept sending him out of the room to go to talk

to the Governor of Texas during this whole time.

So that probably wasn’t exactly realistic, but I would have been,

had he not been there, on the phone with the Governor of Texas

myself.

Governor KEATING. Let me postscript what Senator Nunn said.

The challenge for me, having survived both a natural as well as a

man-made tragedy in my State, was to convince the Federal family

around that table that the best response was in fact a local response, that the local people trusted the police chief and the fire

chief and the health officials locally. They didn’t know who these

Federal people were. What we needed from the Federal Government, from FEMA particularly, were the assets and the assistance

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and, as Dr. Hamburg noticed, the facts to permit us to respond in

an intelligent and in a factual way.

We got into a—I got into somewhat of a—a friendly but firm dialog with the military, who were—whose initial response was, find

out who did it and bomb them. Well, I don’t have a problem with

responding forcefully as an American to anybody who would do this

to our States or our country.

But our challenge, and that is why I commend Senator Nunn as

President, his challenge, which he accepted, was to focus on rescue

and recovery and medical care and quarantine and isolation and

the health side, and we will take care of the bad guys later.

And I think that is something that obviously leadership alone

will make that decision. That would not happen by accident, and

in this case he responded properly.

Senator NUNN. I do believe there are a lot of lessons to be

learned. I will just inject here one on this point. But it was apparent to me that we needed a large group of nurses and doctors, and

we needed to bring them in from all over the country and indeed

perhaps all over the world.

The only way you can do that is probably advanced planning.

Also the question in my mind, I am not up to date on everything

the National Guard is doing in this area, but it was also apparent

to me, and the more I thought about it afterwards the more apparent it has become, that our National Guard forces need to be able

to mobilize all of the reserve medical doctors that they can possibly

get, whether it is Guard doctors or Reserve doctors, and even active

duty officers who have medical knowledge.

And we need to have some advanced planning on that. It

wouldn’t just be the Guard forces with their, you know, with their

guns and with their ability to protect property and so forth. We

would need all of the medical expertise that we can possible muster.

And the public health system and the Public Health Service

would have to be at the heart of that. I believe you said in the beginning, Mr. Chairman, and I want to strongly underscore your

point, because I believe that we really need to pay a lot more attention to our public health system. That is the case even if we don’t

have a terrorist outbreak. That is the case with just natural infectious disease.

Governor KEATING. And as a response to that need for a coordinated mechanism it was for me, representing the State and local

authorities, to say, don’t forget the National Guard best responds

to local oversight and control. Don’t forget the Salvation Army.

Don’t forget the local health officials. Don’t forget the American

Red Cross. Don’t forget the churches and the social services agencies who must be coordinated into this health care response as

well. You can’t have any success unless they are integrated fully

in it.

Senator NUNN. But one final possibility, we’ll get back to the scenario, every one of those people you are trying to mobilize is going

to have to be vaccinated. You can’t expect them to go in there and

expose themselves and their family to smallpox or any other deadly

disease without vaccinations.

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So that is the front line. That is the front line more than any

purely military force. You have got to vaccinate them and you have

got to have that right at the beginning, and that kind of supply

needs to be set aside.

Mr. HAMRE. Mr. Chairman, we are now at the end of the 6th

day. And so let me now go to the next chart.

[Video played.]

Mr. HAMRE. Next chart, please. This is the beginning now of the

third phase of our exercise. It was on the 12th day of the scenario.

The most important thing is the second bullet. Remember, this is—

smallpox is so dangerous, because it is communicable. And every

one person who gets it probably is going to infect 10 more.

Now is the first time that we are starting to see the second wave

of infections. That is the infections of people that came in that

caught from people who were exposed in the very first hour.

As you can see, in the last 48 hours there were 14,000 cases. We

now have over 1,000 dead, another 5,000 that we expected to be

dead within weeks. There are 200 people who died from the vaccination, because there is a small percentage, and we have administered 12 million doses, but now we have 200 that died from the

vaccine. At this stage the medical system is overwhelmed completely.

Next chart, please. This was what the members of the National

Security Council saw. They saw this spread. You see the three red

zones. Those are where the initial attack took place in Oklahoma,

in Atlanta and in Pennsylvania. The Oklahoma attack was successful. But, as you can see, it spreads widely.

Anyway, next chart, please.

These are the cumulative—the results of the cumulative

compounding of the people that have been infected. You see the

cases per day, and you will see it starting to rise at day 18 and

starting to go up sharply. That is the second wave of infections,

people that are catching it from the people who were first infected.

Next chart, please. And this unfortunately was what the National Security Council was looking at. For people that may not be

able to see that in the back of the room, at the end of the first generation of infections, this is approximately December 17th, there

were 3,000 infected, and there were 1,000 expected to be dead.

At the end of the second generation, what we were now looking

at, it would be 30,000 infected, and 10,000 dead. We were forecasting within 2 weeks to 3 weeks that we would have 300,000 who

would be infected and 100,000 dead. As you can see, it goes off the

charts.

It was roughly by the fourth generation that we would expect to

be getting vaccine produced in the emergency production.

Next chart, please.

[Video played.]

Mr. HAMRE. It was at this stage that we were confronting the reality that forcible constraint of citizens’ behavior was probably

going to be required to be able to stop that fourth generation of infections.

Let’s go to the next chart, please.

We’ll talk very briefly about lessons learned.

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Next chart, please. I think we felt that this would cripple the

United States if it were to occur. We have a population that is no

longer inoculated.

For all practical purposes, 80 percent of the population has been

born or is no longer affected by the vaccines when they stopped

back in 1978. So the country is now vulnerable. Local attack quickly becomes a national crisis, and we saw that very quickly once it

spread.

The government response becomes very problematic when it

comes to civil liberties. How do you protect democracy at the same

time that you are trying to save the Nation?

Next chart, please.

We found that it was very hard—we are not very well equipped

to deal with the consequences. I am going ask Jerry Hauer to comment on that when we get around to comments later on. We lack

the stockpiles of vaccine. I’ll ask Peggy Hamburg to briefly speak

to that, because this is one of the key things.

We had 12 million doses, but it is clear that 12 million doses

aren’t going to be enough if we get into this kind of crisis. It is very

likely that you are going to have to change peoples’ behavior. How?

That becomes a key question.

Next chart, please.

We didn’t have the strategy at the table on how to deal with this,

because we have never thought our way through it before, and systematically thinking our way through this kind of a crisis is now

going to become a key imperative.

It clearly is going to require many more exercises. The government is going to have to—and we are very pleased that the person

who for—Governor Thompson is going to be the Coordinator for

Bioterrorism Response. Scott Littlebridge was with us at the exercise.

It is now very clear that public health is a national security imperative. This is not a choice, this is now an imperative.

Next chart, please.

We found that State and local resources were going to be—relations, I should say, are going to be hugely strained at this time.

The perception in Washington is so different from the perception

in the field. That is something that I hope that Governor Keating

and Senator Nunn speak to.

When I say government lacks coherent decisionmaking, this is

not a critique of the exercise. I thought it was the finest national

security discussion I had ever seen, and I have been through about

a dozen of them. It was by far and away the best that I have ever

seen. But it still is very hard to cope with something that you have

never experienced before ever, and we are going to have to start

doing exercises. Hopefully that is as close as we’ll ever get to it.

And finally it is going to take an investment. It is going to take

an investment in public health, it is going take an investment in

research and development. We have got to find some solution to

this problem. I think that concludes, Mr. Chairman.

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Let me turn it to my colleagues, I think, because they had important observations before we wrap up and turn it to you for questions.

[The prepared statements of Mr. Keating, Hon. Sam Nunn, and

Dr. Hamre follow:]

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Mr. SHAYS. Do you all—since I have already lost control of this— do you all have a sense of how you want to proceed?

Mr. HAMRE. I think we can just work down the table.

Mr. SHAYS. Senator Nunn, you look like you’re ready.

Governor KEATING. He is the President, so outranks a mere Governor.

Mr. SHAYS. Mr. President, you have the floor.

Senator NUNN. I lost control of the National Security Council

during this whole exercise, too.

It was two or three real frustrations. One is there was no intelligence, couldn’t find any intelligence. We had no way to link these

attacks with any foreign country. You know, your urge is to retaliate, but you have no idea who to retaliate against. That is the

point that Governor Keating made.

Second, you really know from the beginning, when you first hear

about smallpox, the credibility of the U.S. Government is absolutely essential. And yet, when you are faced with your first news

conference and you turn to your colleagues around the table and

give me the information base, give me the basis on which I am

going to speak to the American people, you know you need to be

candid.

You know you need to be as reasonably accurate, you know you

need not to be reversed from what you said in 3 days. You have

no information base, and yet you have got to reassure people and

you have got to calm them down.

That was one of the most frustrating things, and from that came

the acute awareness that dealing with the media in one of these,

if it becomes a reality in one of these real terrorist attacks or outbreaks of infectious disease which got out of control, dealing with

the U.S. news media would be essential. They would have to be

partners, because if you lost credibility and they basically started

attacking the government you would have nothing but chaos.

And so you certainly couldn’t co-opt the media, and that means

that you have got to have a lot of advanced preparation, you have

got to know what you are talking about. You have got to have the

best spokespeople that you can possibly have at the Federal, State

and local level, and there has to be some coordination in advance.

I think your most credible people would be your health officials.

And I believe that the more I thought about this afterwards, the

more essential it became, in my own mind, to have a whole group

of health officials at every level who work together and who could

speak to this subject with credibility, because I think if you tried

to get law enforcement people out there talking about apprehending someone when people are faced with smallpox right next door,

they really would say, that is not what I am worried about. I am

worried about my family and my children.

So those are a few things. But, we really need to be prepared.

The government is not organized for this. We need to be structured

for it. We need to think about it in advance. We need to do the best

we can in terms of detection. I think we need a global health system that can detect at an early stage any infectious disease, because in the period of globalization when people are moving all

over the world, if we don’t have that early warning, whether it is

from Africa or Asia, or whether it is Oklahoma City to the world,

52

then we are not going to be able to get in front of this kind of episode.

We need a whole lot more vaccine. We need to have an analysis

from our people in the government what the threats really are and

which threats are greatest.

You can’t prepare for every threat. But we have to have an array

of threats as to which threat is greatest in terms of biological, then

we have to weigh chemical and we have to weigh nuclear, we have

to weigh missile defense, we have to weigh all of those threats in

an analytical way, and I don’t think we have done that yet.

Because there is going to have to be some real money spent here

if we are going to get a public health system. The market forces— and this is the other thing that the Governor and I were talking

about earlier. The market forces in this country for health care are

striving for more efficiency. That is what Congress has really tried

to set up, and rightly so. But the more efficient you get, the less

excess capacity you have. And when you get one of these outbreaks

or an infectious disease outbreak, you have got to have excess capacity, you have got to have vaccine that may never be used. The

marketplace is not going to provide that.

The marketplace simply can’t provide it. You can’t ask the pharmaceutical company to go out and for free develop smallpox vaccine

by the millions of doses when the likelihood of that happening is

certainly not very great.

And yet if you are not prepared, you are in real bad shape. So

it is clearly a governmental area. And I think we need to use market forces wherever we can. But there are a lot of areas there that

are going to work against efficiency, but toward the protection of

public health. Most of all, I would underscore preparing and paying

real attention to the public health system of the country.

Mr. SHAYS. Mr. President, who do you want to recognize next?

Senator NUNN. Well, during our scenario, the Governor never

needed to be recognized. He really was just very assertive the

whole time, and we really did enjoy having him there. I am not

sure I would advise any President to have a Governor in the room,

because they would find out how ill-prepared we are up here.

Governor KEATING. But I was respectful, Mr. Chairman.

Mr. SHAYS. I am sure you were.

Governor KEATING. I think the natural result of this should be

a debate, a discussion, of how to respond to both man-made and

natural disasters. What are the likely natural or man-made disasters that you will confront? Those that influence the middle of the

country and are anticipated, tornadoes on the coast, hurricanes, obviously earthquakes. Every fire department, police department,

civil emergency management agency worth its salt has murderboarded the issue of response to a national calamity that happened

and frequently happened on more than several occasions.

You know, in—when something like that happens, you need so

many hospital beds, you need so much water, you need so much

extra power. You need so much quantity of medical supplies. And

you have murder-boarded, you have debated it. You have discussed

it with your National Guard commander, with the civil emergency

management people. The leader of every State has to anticipate

and respond.

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This is the kind of thing that the States, individual States, are

not in a position to anticipate and respond, because they have no

knowledge.

What stunned me, and Dr. Hamburg during the scenario made

a very excellent statement to the effect that medical doctors, many

medical doctors, health care professionals, because smallpox has

been eradicated from the United States and from the world for several generations, that there is no knowledge, no experience. So

when something like this happens, as Senator Nunn said, to have

health care professionals probably coordinated at the State Department of Health level, trained at the State level to recognize plague,

to recognize contagious diseases, and then to be able to access perhaps through FEMA the body of knowledge necessary to respond

quickly. I must confess that obviously I carried the torch of State

and local responsibility, but I was rather surprised at the level of

ignorance, if not prejudice, toward—against, I should say, State

and local responders.

The truth is the first information that people receive locally

about a contagious event or a terrorist act will be from the local

television, radio, local media. It needs to be accurate to the extent

that the information can be provided, that it is accurate. The initial

responders always will be the local police, local fire, Red Cross, the

social service agencies below. They need to have accurate information. They need to be able to access, as—again, as I said, perhaps

through FEMA, I think most respected at the State level to provide

that information, the knowledge base to respond intelligently and

quickly to a calamity to make sure that there is not a greater

swath of tragedy than can be controlled.

For example, in my case I mentioned I closed the airports and

the roads. All of this was spontaneous after I was told as a Governor this is highly contagious, frequently fatal. Well, obviously I

don’t want people coming in and then going out and affecting other

areas if this was an attack on a city in my State. Was that a right

or wrong decision? Well, it was made, and I could only make it

based on the information given to me. The information given at the

scene, because I just happened, as a friend of President Nunn, to

be there, was that quarantined isolation is essential, especially because there is no treatment and because death can occur.

Well, the need to be able to have that information fully available,

quickly available, accurately available to be able to send in the

medical personnel, to be able to be assured of food and water supplies and other health care essentials, particularly vaccines, these

are the kinds of things that we can’t produce locally, we have to

access.

Now, I think when we got into the argument over the nationalization of the Guard, I pointed out if I had to go through 15 different people to get a decision to be made, that’s not good. On the

other hand, if one person, my adjutant, can make the decision or

I can, people that know me, know the Governor, know the mayor,

know the police chief, know the anchor on television, the local officials with excellent information from Washington can make wise

judgments and decisions that will be embraced by the generality of

the populace. But this discussion must take place within the context of State and local first responders. They are the ones, for betVerDate 11-MAY-2000 10:00 Sep 25, 2002 Jkt 000000 PO 00000 Frm 00057 Fmt 6633 Sfmt 6633 C:\DOCS\81593.TXT HGOVREF1 PsN: HGOVREF1
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ter or for ill, that will either do it well or muck it up, and if the

information provided us is inadequate or inaccurate, then the response may be quite different, and the—and the concentric circles

of tragedy may be much wider if the information early on is not

accurate and fully available to those of us at the State and local

level who must make the decision to respond.

Mr. SHAYS. Mr. President, who’s next? Who would you like next?

Dr. Hamburg or Dr. Hauer? Mr. Hauer?

Mr. HAUER. Mr. Chairman, thank you. I’ll be brief. I want to emphasize a number of points that this exercise brought out, and I

think you’ve heard some of them already: One, that the country is

woefully prepared to deal with an incident of bioterrorism. More

importantly, an incident of bioterrorism with a contagious agent

would absolutely devastate this Nation at this point in time.

Some of the issues we had to deal with and struggle with

throughout this exercise are issues that need attention. I must say

that Secretary Thompson, whom I’ve been working with for several

months now, has made this a high priority and is a—as part of the

reorganization of the agency in putting Scott Lilbridge in as special

attention—special assistant is—he wants to ensure that as we

move forward, we address some of the issues that came out of Dark

Winter.

I think one of the things that both the Governor and Senator

Nunn emphasized that we had to deal with was this whole issue

of augmenting medical care at the local level, something that would

be an enormous challenge. I think that the approach that we’ve

taken so far as a Nation is we’ve looked at various little stovepipes

in getting the country prepared. We’ve got a vaccine in place. We’ve

put some teams around the country, the Metropolitan Medical

Strike Teams, but we have not looked at a comprehensive system.

An incident like this is going to take a number of things coming

together, or we are not going to be able to respond.

Let me give you one example. You keep hearing about vaccines.

We clearly at this point in time don’t have enough vaccines in the

United States to deal, one, with an incident. Having the vaccine is

great, but having the ability to vaccinate people is going to be a

challenge in any jurisdiction, particularly larger cities where you

have to vaccinate millions of people in a very short period of time.

The logistical infrastructure necessary to vaccinate the people of

New York City, Los Angeles, Chicago is just—would be mind-boggling. At the same time you’re dealing with the logistical infrastructure necessary to deal with vaccination, you’ve also got to augment the local medical care because, as Senator Nunn said, we’re

in an environment where hospitals are scaling down. We don’t have

residual medical capacity. I don’t know where at this point in time

we would get that augmentation of medical care. We would have

to rely on the DOD, we would have to rely on the National Disaster

Medical System, but if, in fact, you had more than one State, more

than one city, multiple large cities, we would rapidly exhaust that

capacity very quickly.

Then, I think there’s a couple of other important points, and then

I’ll let Dr. Hamburg make her comments. We need to address some

of the issues of isolation and quarantine and the legal authorities

necessary. We struggled with that throughout the exercise. Who

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has the authority to do what? How do we enforce it? At what point

in time do we use force on the citizens of this country? And who

makes that decision?

And then finally I think it’s very important that we look at the

psychological impact of one of these incidents and how psychologically it will impact both the people that are involved and the

responders, something that I don’t think we’ve planned for. I know

that there is some work going on right now, but the psychological

impact of one of these incidents would be absolutely devastating

both on the people that are impacted by the incident and those people that have to respond just by the sheer nature of the stress of

one of these incidents.

I think back when I was a director of emergency management for

New York City, my worst nightmare was one case of smallpox, not

dozens, but if I had gotten a call saying that we had one case of

smallpox, that would be a major, major public health incident in

the city of New York, and at this point in time, as well prepared

as I think we were in New York City, no city, no State is capable

of dealing with an incident like this.

One final point. Smallpox is somewhat unique because unlike anthrax where you have to disseminate the agent here in the country,

where you have to go into the subways, you have to go into an environment like a building like this and spread it, they could actually infect these people just—you know, we have people who are

suicide bombers who want to die for the cause, and with smallpox

you can infect these people overseas, send them into the country.

They never have to be carrying the agent with them, so there’s

nothing to search, and as they become infected somewhere between

the 9th to 12th day after they’ve been exposed, they then start

riding the subways, come into buildings like this. They might have

pox on them, but in the early stages it would probably not raise

a lot of concern, and they could actually be the carriers, the Typhoid Mary’s, so that speak, and spread this thing throughout the

country, and we’d never know what hit us.

Thank you, Mr. Chairman.

[The prepared statement of Mr. Hauer follows:]

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Mr. SHAYS. Dr. Hamburg.

Dr. HAMBURG. Thank you. I’ll try to be brief so we can get to

your questions.

I should say at the outset that I came to this exercise and come

to the discussion today with both a local and Federal perspective.

I served 6 years as New York City’s Health Commissioner, was

Health Commissioner during the bombing of the World Trade Center, and also in that capacity clearly managed a wide range of infectious disease and epidemics, and also began a program to deal

with the threat of bioterrorism. I then spent close to 4 years at

HHS helping to shape a still fledgling bioterrorism initiative there.

So for me, addressing these kinds of issues could not be of greater

importance, and the importance of the partnership and planning

that has to occur today in order to address the different levels of

government and the cross-cutting nature of the response required

is absolutely essential.

I think that the most important point, and why in some ways

this exercise, I think, was somewhat unique, was that it really

demonstrated how a bioterrorist event would be different from the

other kinds of conventional terrorist attacks that we are more familiar with, sadly; or even an event using another weapon of mass

destruction, that it would really unfold much more slowly over time

as a disease epidemic; and that the traditional first responders

from a lights-and-sirens kind of response would be police and fire,

but would be Public Health in the medical care system, and that

we really need to make sure that we invest adequately in a robust

public health system and support our medical care system so that

we can provide the response that will be needed to contain and control an event like this.

That means that we need to really invest in our public health

system. We need to improve our disease surveillance systems, our

outbreak investigation capacity so that we can rapidly detect an

event if it occurs, because rapid mobilization of response is what’s

going to be key to saving lives and containing the disease. We have

to make sure that we have a medical care capacity, as others have

said, that has enough flexibility in it that we can respond. This will

be key for both naturally occurring and intentionally caused

events. We do need to develop new drugs, vaccines, and diagnostics

to make our Nation better prepared. We need to invest in research

so that not only are we developing the drugs and vaccines that we

know today might be effective against agents used in a potential

bioterrorist event, but we have to think about new ways and new

approaches that might give us greater capacity in the years to

come.

For example, not just thinking about one drug, one disease, but

thinking about the possibility that in the future we might see genetically engineered threats or agents that we hadn’t previously

dealt with, or even as we speak today there are many diseases that

exist in the world, many microbial agents that threaten the human

population for which we have no drugs or vaccines. So we need to

really develop an appropriate research agenda and invest in that.

And I think critically Dark Winter underscored for all of us the

importance of planning, preparing, and exercising. We have a very

complicated challenge before us that will require many different

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agencies and levels of government to come together. We cannot afford to be learning things for the first time in the midst of a crisis.

We must think about the types of challenges before us, and we

must think about the kinds of strategies that would be effective in

addressing them and put in place the necessary systems.

And as I think, as others have mentioned, the good news here

is that many of those investments will have immediate payoffs in

our ability as a Nation to deal with naturally occurring infectious

disease threats. So we appreciate what you’re doing to help make

our Nation stronger against the threat of infectious disease.

[The prepared statement of Dr. Hamburg follows:]

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Mr. SHAYS. Before I recognize Mr. Gilman for the first questions,

I just want to make a few observations as chairman. One is I found

myself getting very uptight. I thought, what are you, nervous? I

found myself feeling very uneasy, and then thinking you can’t

laugh when you’re talking about something so serious because, you

know, that’s kind of absurd.

And I was thinking that you—the two unrealistic things for me,

the only two that I really heard, is, one, that you would have been

in Washington, and, two, that you would have stayed in Washington because, knowing you, you would have gone back home with

your constituents and your family.

But then I found myself saying now, do you get the vaccine? And

then if you get the vaccine, are you going to get the vaccine and

not allow your wife to or any other family member? And then if you

get the vaccine, and then you order people that they have to stay

in Oklahoma, the outcry is, yeah, it’s easy for you to do, you know,

and just the implications in the talk shows and the—it was a

chilling, chilling thing to see this news broadcast and knowing that

was less stated than CNN. I mean, I can imagine what some would

have said and how it would have been said.

So I just find myself in one sense grateful as hell, frankly, that

you all have been able to dramatize this, because there have been

a number of people who have been trying to say to people in the

United States and to our government, wake up, and not to steal

something from Mr. Tierney, but to give him credit for this question, he said, which is more likely, an errant missile from North

Korea or this kind of experience, a terrorist attack? Not that they

are mutually exclusive, but if you told me I only had the dollars

for one, there’s no question that I would put my dollars here.

Then just two other points. Senator Nunn, your comment about

the World Health Organization, I chaired the Human Resource

Subcommittee of Government Reform. We oversaw HHS, FDA,

CDC, VA, a whole host of others related to health care, and I am

in awe of the World Health Organization. I mean, the attack I fear

most is the pathogen. It’s not the soldier with the weapon. And

some of these individuals in the World Health Organization go

around the world unarmed trying to determine what is this outbreak.

And I conclude by just saying to you I have so many questions.

I mean, I couldn’t keep up with the questions that you all generated by your presentations. So I know you—like you wanted to

just make a point since I mentioned your comment to me, but I

would——

Mr. TIERNEY. No. I’ll wait.

Mr. SHAYS. OK. You’ll have plenty of time.

Mr. Gilman, you have the floor.

Mr. GILMAN. Thank you very much, Mr. Chairman.

It’s certainly startling to hear all of these observations by this

panel. Let me ask—I think it’s Mr. Hamre—you’ve been the sort

of the guide to putting it together; am I right?

Mr. HAMRE. Sir, I was—I head up one of the three organizations

that cosponsored it. We did coordinate it at CSIS. Sue Reingold behind me was the coordinator. Randy Larson was for Answer Corp.,

Tom Inglesby for the Johns Hopkins Center, and he’s——

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Mr. GILMAN. Was it Mr. Larson’s idea, this initial thinking about

all of this?

Mr. HAMRE. Well, I think Colonel Larson and Sue Reingold first

started together, but the three were the teammates, and Tara

O’Toole, who’s not with us today——

Mr. GILMAN. Did any government agency participate, any of our

Federal agencies participate in your Dark Winter?

Mr. HAMRE. We had observers that were at the exercise from the

Federal Government, from the various offices that I said. Scott

Lilbridge, who is going to the coordinator for Governor Thompson,

Secretary Thompson, he was there; very important that he could

participate. We had, I think, six committees, congressional committees, had representatives there.

Mr. GILMAN. Six of our committees? Which ones?

Mr. HAMRE. Your committee was there, and we had representatives from two committees in the Senate, and then we had individual offices.

Mr. GILMAN. When did you conduct your seminar?

Mr. HAMRE. We did it on June 22nd and 23rd, sir.

Mr. GILMAN. In 2 days?

Mr. HAMRE. Yes, sir. It was on Friday and——

Mr. GILMAN. I want to commend you all as panelists. You certainly put together some information that we ought to make good

use of. Now, what are you going to do? You’ve got lessons learned,

and I see you have about nine recommendations. No, I’m sorry,

you’ve got 12, 12 significant recommendations. What are you going

to do with all of these?

Mr. HAMRE. We ran out of computer disks or we would have

probably had about 40. But, sir, we’re in the process right now of

producing a report that’s part of the grant that we were given the

McCormick Tribune Foundation and by the Memorial Institute for

the Prevention of Terrorism——

Mr. GILMAN. And what are you going to do with that report?

Mr. HAMRE. That is going to be circulated and made available to

the Congress and the executive branch. It really highlights the

things that have to be done. We’ve signaled some of them here. The

most important is that the government needs to start exercising

itself, it needs to start going through this process to find out what

we would do when we’re confronted with that sort of a dilemma.

Mr. GILMAN. Where would you focus that attention? Who should

be the implementer now of all of this? Should there be a central

office, for example, to implement your recommendations?

Mr. HAMRE. Sir, I think that President Bush has decided that

he’s going to put the focal point with FEMA, and the Director of

FEMA is going to be taking the lead. The Vice President’s office is

coordinating an interagency review process right now.

Mr. GILMAN. Of this report?

Mr. HAMRE. No, sir, of the issues in general, and we’ll be sharing

it with FEMA’s Director, Mr. Lacy Suiter. We’ll be getting together

with him later this week, and I’m meeting tomorrow with the Vice

President’s Chief of Staff.

Mr. GILMAN. Now, what would your panel feel is the appropriate

central authority for instituting your comprehensive plan?

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Mr. HAMRE. Well, I will let others speak, but, sir, I think that

it has to be—President Bush needs to decide how he wants to organize his government. I think he’s decided that. I think he wants to

put the focal point on FEMA and then have the Vice President be

the coordinator of the interagency review that’s required to support

that. So I feel that decision’s been made. I think we ought to be

doing what we can to help him make that decision work.

Mr. GILMAN. Let me ask our other panelists, what do you recommend for proper and effective implementation of your findings?

Governor Keating.

Governor KEATING. Well, let me analogize, if I may, Mr. Gilman,

to the Oklahoma City bombing. We had a criminal investigation

going on simultaneously with a rescue and recovery operation. It

would be a similar event if this were to occur, a criminal investigation in companionship with a rescue and recovery and health care

response. Obviously local police and the FBI would be in charge of

the criminal investigation, but they are not health care providers.

And the rescue and recovery people, the local civil emergency management people are not criminal investigators.

The resources that are needed for the purpose of responding to

the health care challenge, not the criminal investigation—those resources are already fully available in the FBI—have to be directed

through an entity that the State and local governments trust and

frequently work with. In my judgment, that is FEMA. During the

tornadoes that we had 2 years ago, the most severe ever to strike

the United States, and, of course, the Oklahoma City tragedy of

April 19, 1995, under then Director James Lee Witt, the sources

that were provided were provided promptly and fully, the advice

and counsel promptly and fully in companionship with State and

local authorities.

It’s a mistake to have someone say, I’m in charge here. There has

to be a sense of comity and goodwill and joint sharing of responsibility, and that can be, is done, all over America all the time. In

this kind of situation, you need the medical and the health care

fast, and, in my judgment, only FEMA should be able to provide

because we work with FEMA always.

Mr. GILMAN. You think FEMA, then, is the appropriate

agency—— Governor KEATING. In my judgment, yes, Mr. Gilman.

Mr. GILMAN. Senator Nunn.

Senator NUNN. I think the Governor’s last point is what I’d like

to underscore. This cuts across agency lines. I’ve heard John

Hamre say a number of times that government’s involved and

structured as stovepipes, and yet vertically, but the problem here

is horizontal. So it goes across a lot of different agencies.

I commend Secretary Thompson for stepping out and having real

emphasis on this, as we heard from Jerry Hauer. I also believe that

someone from the National Security Council is going to have to

have this portfolio, and I would have someone have this portfolio

who’s not spread too thin so that they can look across governmental agencies. I think the State and Federal has got to be given

a lot of attention from the National Security Council and the HHS

point of view. I believe it’s essential that HHS officials be able to

coordinate and have the President’s blessing in advance clearly

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made—made clear to the other Cabinet officials, with Department

of Defense, with the CIA.

I’ve been told that there are some HHS officials in key spots that

deal with this overall subject that don’t have clearances. We are

going to have to have coordination between health and security. I

believe that is one of the fundamental underlying principles here

is health is security, and an attack on the public health in this

country is a security threat, and we have to join those. So I think

that’s the way I would approach it.

I also believe—— Mr. GILMAN. Well, Senator, if I might interrupt then, are you disagreeing that FEMA should have the ultimate authority?

Senator NUNN. I think FEMA is going to have to play a big role,

but FEMA does not have the health kind of capability that they are

going to need. They’re going to have to go into the local communities and deal with doctors, and they’re going to have to do it up

here in Washington.

Mr. GILMAN. What I’m seeking is who should be the—have the

primary authority here?

Governor KEATING. Mr. Gilman, let me postscript what I said,

and I’m afraid I didn’t fully develop my thought. What happens

here is very relevant to what happens in Philadelphia or Atlanta

or Oklahoma City. The coordinating mechanism here, for example,

as Senator Nunn has indicated, if—within the National Security

Council there’s a portfolio for this. If there is a coordinative group

put together in Washington under the Vice President’s direction or

under the FEMA Director’s direction, it doesn’t matter as long as

HHS, everybody’s around the table, Department of Defense, developing the book, how do you respond to this, smallpox or a hurricane or tornado? Then you take the book and give it to FEMA to

share it with State and local officials who’ll have to implement the

results of the book.

What I’m saying is to have a whole panoply of Federal agencies

descending on a city won’t work because the local health commissioner, the local mayor, the local police chief, the local National

Guard commander, those are the ones that will actually implement

the book, the reaction to whatever this tragedy may be.

Mr. GILMAN. Governor—— Governor KEATING. How it’s coordinated here is not as important

as having some kind of product that is shared with FEMA that we

deal with daily in response to man-made and natural calamities.

Mr. GILMAN. Governor, that’s why we recommend a specific agency or a specific comprehensive coordinator. We just went through

a hearing on fragmentation by so many agencies on proper supplies

for our defense forces—we found was fragmented through a number of agencies, and there was really no central controller, and

that’s why I’m seeking——

Senator NUNN. Well, the key here is it’s got to come under the

President. He’s got to direct it because unless his authority’s behind it, my experience is you can pass a piece of legislation and say

somebody’s czar of something, and yet if the czar doesn’t have any

troops out, and if he doesn’t have an agency, and if he doesn’t have

a large budget, and if he doesn’t have power in the bureaucracy,

nothing happens.

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I remember when we appointed a drug czar, Mr. Chairman,

many years ago.

Mr. GILMAN. We worked together on that.

Senator NUNN. Yeah, we did, and I supported that. But after

he’d been in office about a year, year and a half, he came to see

me, and I was shocked to find what he wanted me to do was get

him an appointment with people at the Department of Defense. He

hadn’t been able to get an appointment at that stage. Now, we had

the drug czar up here, but he didn’t have anybody under him. He

didn’t have any power—— Mr. GILMAN. We finally got him into the Cabinet.

I have a moment or two left. Dr. Hamburg.

Dr. HAMBURG. I think it is key that we have a national plan and

one that involves a true cross-cutting approach. Preferably I think,

and it’s my personal opinion, there needs to be some mechanism

of coordination that’s central that has real accountability for both

programs and to some degree budgets so that we really know

across this wide array of agencies—— Mr. GILMAN. I think we recognize that. What I’m looking for is

do you—have do you folks have some specific recommendation of

who could do that most effectively?

Dr. HAMBURG. Your question in a way was who on the ground

should be the lead also, though; right?

Mr. GILMAN. Who nationally should take control of all of this?

Dr. HAMBURG. You know, I think it actually could be a number

of different players, but the key is that it be clearly defined and

that we build around that. I think, as Dr. Hamre said, the President has made the decision that it should be FEMA, and I think

operating on that assumption, that there are very natural partnerships that can then unfold. We want to build systems to respond

to this threat that complement the kinds of activities that we do

every day either in public health, disease control, or in emergency

response so that we are not creating—— Mr. GILMAN. I’m exceeding my time, and the chairman is getting

a little antsy on his gavel. Mr. Hauer, could you just answer——

Mr. HAUER. Yeah. Very simply, FEMA needs to be the overarching agency that does the coordination of this at the Federal

level and then rely on agencies like HHS for the expertise to deal

with the unique parts of the bioterrorists—— Mr. GILMAN. Thank you very much. Thank you, Mr. Chairman.

Mr. SHAYS. I thank the gentleman.

Just another observation. I felt like I’ve been in the middle of a

movie, and maybe that’s why I was anxious. I wanted to know how

it turned out. And so I asked my staff how did we finally get a handle on it, you know, 12 million vaccines out, the disease spreading?

And the response was we did not get a handle on it. They stopped

the exercise before resolution. Kind of scary, huh?

Senator NUNN. One thing, we were faced with a dilemma of having received very graciously from Russia a very large supply of vaccines, and we were then trying to decide whether to use them, and,

of course, one of my national security people popped up and said,

what if it’s sabotage? Can we test them? And we were still waiting

on the other emergency vaccines to come in, and we were in panic,

as you saw on television. So we can’t contend that we solved this

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problem, but I do think that no policy person, Congress or the

White House, could sit through this and not say, we’d better get

off the dime, we’d better do something about it.

There’s one other thought I’d like to inject that I don’t think has

been covered. We basically need to have the people who deal with

biology understand the sensitivity of the materials they are dealing

with if they got in the wrong hands. There needs to be an ethical

best practices safeguarding system in this country to begin with,

but throughout the world, in dealing with these materials, most of

which are local, legal and legitimate. It’s not like nuclear materials,

which they are hopefully safeguarded except in certain spots, and

we’re trying to work on that in the Soviet Union, but the biological

materials are part of our everyday commerce.

Mr. SHAYS. Thank you.

Mr. Tierney, you have the chair as long as you want it, give or

take.

Mr. TIERNEY. Thank you.

Thank you all for your testimony and for going through that exercise. I didn’t make an opening statement, so I’m going to take the

liberty of just making at least an opening comment here.

Senator, you talked very briefly about prioritizing the threats on

this country, and I couldn’t agree with you more. I’d be remiss for

my own personal reasons in not just saying here that I think it’s

abominable that we are spending so much time on reinventing Star

Wars and all this other silliness that’s going on here without attending to a real prioritization of what real threats are and making

a determination as to what really needs our attention first and how

deeply that attention is needed.

I note also that this administration just pulled out of the protocol

for the biological weapons convention, so at least in the short term

we won’t be getting any real notice for any situation like this, nor

the opportunity to inspect or to move in that direction, both of

which I find a little disturbing.

Let me ask, I would assume, Mr. Hauer, that we don’t have the

hospital capacity right now if we were to get involved in an incident like this with all the hospitals downsizing. I would assume

that if we’re really going to be ready for this type of an incident,

we would try to think of some system, statewide at least, Governor,

if not nationally, to determine how many hospitals we ought to

have, where they ought to be placed with ready access to people.

Mr. HAUER. You’re absolutely right. I think, though, it’s unrealistic to think that hospitals are going to develop a surplus capacity

and just have it on standby for an incident like this just because

of the cost. I think the issue at this point in time is trying to figure

out how, when we have an incident like this, whether it’s anthrax,

smallpox, or some other agent, we can rapidly increase capacity

both in existing facilities by augmenting staff and then finding alternate care facilities or casualty collection points where we can

triage people who are sick with either smallpox or anthrax or

something along those lines, and we take them and put them in a

facility, and we augment the local medical care either with State

resources, or more than likely, particularly with the contagious

agent like smallpox, we’ll have to augment them with Federal medical assets.

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Mr. TIERNEY. Thank you. For anybody who wants to answer this

question, I assume that there was some determination made or at

least some thought given to the fact whether or not we would want

to have enough vaccine for forseeable types of incidents for our population, or was it that we were thinking of having an infrastructure

in place that could readily produce the kinds of vaccines and antibiotics that we would need?

Dr. HAMBURG. Well, with respect to the smallpox situation, there

was a remaining stockpile from the days when we actually were

addressing smallpox as a disease, and the smallpox vaccine luckily

is fairly durable. There was a decision made a few years ago that

we needed more smallpox vaccine as a Nation to protect against

this potential threat. Obviously it remains a low-probability threat,

but a very high consequence as Dark Winter, I think, so compellingly illustrated. And so the Department of Health and Human

Services does now have a contract with a private manufacturer to

produce 40 million new doses of smallpox vaccine.

That is a research and development task, though, and the current plan, which is somewhat accelerated compared to some vaccine development, is that those doses would be available in 2005.

In the exercise we simulated the possibility that we might try to

mobilize those more quickly. At a stage that we’re at now, one

could produce millions of vaccine doses potentially, but it would be

untested vaccine, which, of course, raises a whole set of other

issues in terms of what does it mean to in an emergency use drugs

or vaccines that haven’t yet been licensed? And we made the decision early on that given the gravity of the situation, we would certainly move forward.

But smallpox vaccine is one critical need that I think as a Nation

we need to continue to address, make sure that we do develop that

additional vaccine supply, and I think that we need to make sure

that we think about the investment in developing new smallpox

vaccine and other vaccines against the bioterrorist threat as a security concern, and make sure that we’re not taking dollars from

other existing medical problems to support that vaccine development, but that we see it as part of our national security investment.

Mr. TIERNEY. Just for the additional doses of this smallpox vaccine you’re talking about, it’s about $350 million, and that is for

smallpox, but I guess I’d like to also ask you do we look at the

other anticipated things that might happen, anthrax or whatever,

and also decide what a fair amount is to set aside on those?

Dr. HAMBURG. Absolutely. I think we need to really step back,

and I wanted to make the comment earlier, in addition to thinking

about what do we need to do in order to improve on the ground response, we also need to ask the bigger question about what do we

need to prepare, overall preparedness. And part of that is really defining the set of threats as we see them today in looking at what

do we have to respond to them and making sure that we develop

new drugs, vaccines, and diagnostics for rapid detection to address

those, and that we also think into the future about what we may

need, given what we know about the new understandings of biotechnology capacity, the revolution in genomics, etc. We can’t just

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assume that the diseases we know today are the threats of the future.

So I think we really do need to think very carefully about developing a research and development agenda, and there is no doubt,

as Senator Nunn indicated earlier, that we cannot rely on the marketplace to serve our country’s needs in terms of some of the new

pharmaceutical tools that we really will require to be truly prepared.

Mr. TIERNEY. But the shelf life—I guess the shelf life of these

things, if you make that vaccine, how long is it going to be good

for?

Dr. HAMBURG. It depends on the particular vaccine. The smallpox vaccine stockpile that we have today is really very old. In the

best of all possible worlds, I think we wouldn’t choose to keep that

vaccine on the shelf that long, but it’s tested periodically, and it

has been determined and FDA approved as good to go in a crisis.

But, you know, depending on the drug or the vaccine, there are

shelf lives that come into being. When there’s a drug or vaccine

that’s used routinely in medical care, you can create a stockpile

mechanism that allows you to recycle those drugs or vaccines so

that you don’t have to just put them in a warehouse and throw

them away, but that you could have the capacity to surge if you

needed it in a crisis, but use those in routine care. Something like

smallpox, we don’t use it routinely, so it will be stockpiled in the

traditional sense of the word.

Mr. HAUER. I want to allude to a point you had made, and I

think it’s one of the disconnects that we’ve got at the Federal level.

As you look at vaccine development, trying to look at research and

development activities on new vaccines, you have to really look at

the intelligence that we’re getting and try and figure out what the

intelligence is and where you’ve got to put your money. And there

is a disconnect between the Intelligence Community and the community in Health and Human Services in trying to understand

what the real threats are.

Mr. TIERNEY. I suppose some of that comes from the CDC and

the sort of assessments of what’s going on in other countries and

what’s showing up, but I—it also brings me back to the biological

weapons convention. It’s important that we get some sort of a protocol on this if we’re going to have any type of advanced notice or

any—the Center’s going to just keep making these things forever.

The idea is to try to get some negotiated concept of how we’re going

to stall the development, or to the extent we can’t do that, at least

try to put something in place that gives us some ability to have

some notice, if I’m not mistaken on that.

Mr. HAUER. That’s correct.

Mr. TIERNEY. Governor, I would assume that you’re—it sounds

like you’re very familiar with all the local things of training and

equipment, coordination, communication, structure, everything that

would be needed. It would be expected reasonably that the Federal

Government would pick up some of the resources for that—local

communities, I would guess; right?

Governor KEATING. Well, yes, Congressman. And let me postscript what Dr. Hamburg said because—and Mr. Hauer said because it’s very important that you vacuum intelligence sources to

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determine what is out there and what’s needed to respond to whatever the calamity—anticipated calamity might be. We do that all

the time at the State and local level for man-made disasters, and

everyone, as I noted, prepares for these disasters, and we know

pretty well the kind of things we need in order to respond.

This is a situation where we don’t know because we’ve never

seen anything like this. Remember, FEMA is State and local— FEMA consists of State and local firefighters, rescue workers and

the like. The FEMA people that came to Oklahoma City, for example, came from Fairfax County, VA; from Prince George’s County,

MD; from Sacramento and from Los Angeles; and from Puget

Sound; and from Miami-Dade and the like, Phoenix. All of them

are local people who have been thoroughly trained to respond to,

for example, building collapses in this particular case.

That’s all we’re saying is that once the Federal Government figures out what’s the problem, then the book that results from that

analysis of what is the problem is distributed to the local and—the

people at the local level, the State level in every State, an individual and an entity that’s responsible for disaster preparedness and

response, and we implement the book.

Mr. TIERNEY. To the extent that the book may require that you

have certain equipment in local police or fire departments or other

agencies, that you have certain training exercises that go on, certain ability to have people that can communicate and coordinate

those activities or whatever, is it your understanding that the local

communities would be able to absorb those costs?

Governor KEATING. No, not necessarily. Some yes and some no,

and some, for example, already anticipating certain types of natural disasters, have equipment and assets in place. But it depends

on the nature of the beast. If there’s a huge run on hospitals, there

aren’t sufficient resources to build new hospitals, and you wouldn’t

anyway. You’d use college dormitories, for example, remote college

campuses, as we did in the scenario here. But you have to know

what it is that you’re dealing with, and then you determine whether or not you have the assets in place or if you need to import the

assets. Obviously it’s a lot cheaper to distribute the assets on a

need basis as opposed to having them in a warehouse someplace,

but it depends on the nature of the beast, the nature of the extent,

how large and how expensive the response would be.

Mr. TIERNEY. Senator Nunn, let me just close—I think you’re an

individual known for having probably spent a great deal of time

thinking about and weighing threats to this country in an analytical way. On a scale of 1 to 10, with 1 being a very likely scenario

and 10 being least likely, what would be—assess this type of a

threat to this Nation.

Senator NUNN. It’s really hard to assess the smallpox part of it

as to whether it’s smallpox——

Mr. TIERNEY. As to——

Senator NUNN. But some type of biological attack against the

United States, I’d say the probability of it happening in the next

few years is very high. I think that’s probably a greater threat than

the nuclear, although we’ve got to be very zealous in trying to safeguard nuclear materials in the former Soviet Union. As you know,

I spent a lot of time on that, and I think that is a real danger, but

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I also believe the dissemination of biological would be something a

terrorist group could carry out much easier than nuclear, in my

opinion. It wouldn’t be easy. It’s not as easy as some might say, but

it’s doable, and I think the nuclear part would be much greater because the nuclear material would be harder to get access to.

So I always have feared attack by a group that doesn’t have a

return address more than I have a country. That way we would

know, for instance, if a missile were launched, and we would know

where it came from, and they would in effect be committing suicide

as a nation. So I fear this kind of scenario. I would not exclude

chemical also as more likely.

I might just add as one footnote, I’ve now spent a third to a half

of my time on an organization called NTI, Nuclear Threat Initiative, but we’re including the biological and the chemical. We’re fortunate to have Dr. Hamburg, who’s heading up the biological, and

we’re going to be determining what a private foundation can do in

this area. Ted Turner is funding it. We don’t have unlimited funds.

The Federal Government is going to have to do most of the heavy

lifting, but we’re looking at this early warning surveillance system,

whether we can help the World Health Organization and others

beef up that.

We’re looking at the question of best practices, safeguarding materials, whether we can inspire the scientific community in this

country and around the globe to organize themselves as the nuclear

industry has done.

The electric utility industry, after Chernobyl and after Three

Mile Island, organized, and they have their own peer reviews. They

have their own safety mechanisms not funded by the government.

I think the pharmaceutical companies of this country and the

world have a real opportunity here to step up to the plate and help

safeguard a lot of this with their own resources. So the scientific

community is going to have to be much more aware.

And finally, we’re looking at the possibility of really trying to

help get jobs, meaningful jobs, for the former Soviet Union scientists that know how to make these biological weapons and spent

a whole lifetime doing so, but don’t know how they’re going to feed

their families. That is one of the most crucial other aspects of proliferation in the biological arena, in my view. So we’re going to be

active in this area, but we know that the big picture has to be dealt

with by the governments of the world.

Mr. HAMRE. Mr. Tierney, may I just say——

Mr. TIERNEY. Sure.

Mr. HAMRE. We had a biological terrorist incident in this country. People forgot about it. It was 10 years ago. There was a kooky

little outfit out in the Pacific Northwest that sprayed salmonella on

a salad bar and infected, you know, hundreds of people. We’ve had

it in this country. Now, fortunately, it was, I guess you’d say, more

on a scale of a nuisance, but, you know, there are enough nuts out

there that would want to make a point, and this is not in the realm

of the theoretical. This is—— Senator NUNN. The Aum Shinrikyo, I had a set of hearings in

1995 where I sent investigators to Japan and looked at the whole

Aum Shinrikyo attack over there, which was chemical, but they

were working on biological, and this was a group that had hunVerDate 11-MAY-2000 10:00 Sep 25, 2002 Jkt 000000 PO 00000 Frm 00083 Fmt 6633 Sfmt 6633 C:\DOCS\81593.TXT HGOVREF1 PsN: HGOVREF1
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dreds of millions of assets. They had tried to develop biological

weapons. They developed chemical weapons. They’d had other attacks, and they were even doing some experimentation in Australia

on sheep with biological and chemical weapons, and all of that was

going on with substantial assets in Russia, and they never had appeared on the radar screen of either our intelligence or our law enforcement agencies. We never heard of them until this attack. So

it shows the need for coordination, too, with other nations in the

world.

Mr. HAUER. Yeah. The Aum on eight different occasions tried to

use biological weapons and did not overcome some of the technical

problems encountered with these types of agents. But as the Senator said, this was very high on the radar screen. They tried using

it. They tried killing a judge with anthrax in Japan and were not

able to use the agent successfully, but it’s only a matter of time between—before some of the technical issues are overcome by some

group somewhere.

Mr. TIERNEY. Well, I thank all of you for the work you’ve done

on this, and, Senator Nunn, you in particular for the work you’ve

done in the nuclear area in the past also.

Senator NUNN. Thank you very much.

Mr. SHAYS. Senator, I notice you’re looking at the clock. It’s getting a little late, I realize—— Senator NUNN. I’m thinking of you because you’ve got another

panel. I’ve been in your spot.

Mr. SHAYS. I’ll tell you, this is so fascinating that sometimes you

get antsy to ask the questions. I wanted to hear you all share what

you know before we even got to the questions. I’m going to kind of

jump around the board here.

I’m interested, Mr. President, when you had the thought that

Iran might have been responsible, did the military step in and advocate a response, and then did they get in any question about the

soldiers being vaccinated and taking up some of those valuable—— Senator NUNN. Good questions, Mr. Chairman. Two points. One

is right at the very beginning of this scenario, the Secretary of Defense demanded we set aside something like 3 million doses of vaccine for the U.S. military. Of course, my first instinct is to protect

the military, but after 10 seconds reflection, the local health officials in Oklahoma City and Georgia and Pennsylvania were the

ones we had to take care of first and foremost.

The scenario that we had in terms of foreign was the Iraqi mobilization of tanks toward the Kuwaiti border, and the news media

speculation on Iraq being involved in this was not backed up by

anybody that had any intelligence. We got no intelligence. I told my

good friend Jim Woolsey, who was then the Director of CIA, that

he gave me one hell of a lot of policy advice sitting around the table

and not one ounce of intelligence.

Mr. SHAYS. You know, knowing him as little as I do, I have a

feeling he didn’t react kindly to that comment.

This is the 20th hearing we’ve had on this issue, or briefing, and

I keep learning more things. Now, obviously we’ve had 40 government agencies on the Federal level. We have 3,000 plus State,

county, local governments, and they have all their departments and

agencies. So we’re talking about a lot of people. I’m fascinated by

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this concept of ultimately, you know, we don’t write a playbook, so

we don’t know exactly what a President is going to do and what

authority he’s going to take and what authority the Governor is

going to take. But it just strikes me that what ultimately will happen is that the President will decide whatever the heck he or she

wants, and that’s what a Governor is going to do. I mean, you’re

not going to—you’re not going to question your counsel to say, you

know, do you have the authority?

Maybe, Governor Keating, you could tell me how you would respond. Let me say you might question them, you just might not listen to them.

Governor KEATING. Of course. Mr. Chairman, I think everyone in

a public position will try to do the best job he or she can with the

information at his or her disposal, and that is the problem. In this

case there simply wasn’t the information—the level of ignorance at

least at the local level was very high, and the willingness to respond intelligently and forthrightly and quickly was limited by the

intelligence, the knowledge at hand.

So what I’m saying is that the President with the Governors,

there is a relationship, I think, generally of comity and goodwill.

If something like this were to happen in a multi-State environment, the President will look to the Governors to provide the execution, and the Governors will look to the mayors and community

leaders to provide for the execution of whatever the plan is to respond, and that plan has to be federally developed. There’s simply

no way that the Governor of Florida, the Governor of Oregon, the

Governor of New York, whatever, would anticipate nor prepare for,

either with assets or with intelligence, a response to a smallpox or

an anthrax attack.

But what struck me, and I made this comment at our session,

was if you’re preparing for war, you anticipate types of wounds

that your troops will receive, and puncture wounds are what bullets create. So your people are trained, medical people, to respond

to puncture wounds. If this kind of scenario is what the Government of the United States feels could happen to our people, then

to have doctors at the local level have no knowledge of it, no knowledge of how to respond to a puncture wound is potentially grossly

negligent.

Mr. SHAYS. Could you just touch as briefly as you can on this

issue: Did the power vacuum get filled by a President and Governor who just said, I’ve got to run with this? Do you think it’s possible to try to anticipate the powers that would be needed, or do

we just kind of let it unfold with people logically responding to a

President, logically responding to a Governor?

Governor KEATING. Well, there’s a combination of both really.

Mr. SHAYS. And then I’d like Senator Nunn——

Governor KEATING. I mean, there’s a combination of both. I think

in the case of most States, our civil emergency management people

train for scenarios that they anticipate will happen to their State,

whether it’s a hurricane or a string of traffic fatalities, the shutdown of a subway by—— Mr. SHAYS. I hear that part.

Governor KEATING. So I’m saying, so they’re training, and if an

event occurs, the media, everybody comes to us for a response, and

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in the case, for example, of the Oklahoma City bombing, President

Clinton called me. We talked about what I needed, what he was

willing to provide. Everything worked like clockwork because we

had highly professional people on the ground. But if he had no idea

what to do because he had no idea what happened, if I didn’t know

what to do because all of a sudden people were falling over dying

and we don’t have a clue as to what is causing this, we have a

problem. It’s intelligence information that’s most in need.

Mr. SHAYS. Right. I don’t mean to be disrespectful. I’m still pursuing this one question. It seems to me, Senator Nunn, that in the

course of your exercise of responsibility as President, that you basically decided to make some decisions without necessarily knowing

whether you had the authority or not, because you knew somebody

had to make them.

Senator NUNN. You have to make them, and you have to just

step up to the plate and take the best swing you can, because at

that State you don’t have time for a legal research job. You have

to swing, and you have to have a partnership with the State and

local, and I think that’s going to depend in the future about whether FEMA can take this ball and really roll with it.

I think FEMA has dramatically improved during the last few

years, but they are going to basically have a lot of support from the

White House because they’re going to have to cut across agencies,

and they’re going to have to do a lot of groundwork with our counterparts at the State level. If I’m dealing with Governor Keating in

this crisis, and he’s back home and not in the National Security

Council, which would be probably a more natural event, then the

question of how well FEMA’s prepared with his people in advance

for this or other type scenarios would be important in terms of how

well he and I would be communicating or we’d be getting feeds

from our own people.

Mr. SHAYS. Obviously, Governor Keating, there’s not a person in

this room that doesn’t know the experience you went through, so

you bring tremendous expertise. In that case, though, it was— which is true in a chemical attack or explosive or conventional or

even nuclear, it’s pretty much there. What a President is wrestling

with—what you wrestled with is in the event it goes outside the

city, it goes everywhere. So it introduces so many gigantic question

marks.

But maybe I can ask this of the other panelists as well. If Congress were to decide the power of a President, or the power of a

Governor in this case, my concern would be that we would start to

get into an issue of, my gosh, we have civil liberties here, which

is obviously important, but then we would try to write a scenario

that would respond to both sides; in the end, we might lock a President in. Is the ambiguity almost better—and then I’m going to get

to another question. I’m still on this question. Is the ambiguity almost better because it would be hard to write—maybe, Dr. Hamre,

you could respond first—it would be hard to write a scenario without getting in gigantic debates about civil liberties and so on and

so forth?

Mr. HAMRE. Sure. I tell you what, I walked away from one conclusion that was overwhelming in my mind, and that is why we

have elected politicians who are national decisionmakers at a time

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like this. This is now where all of the issues that are so central to

how we love and want our country, freedom, liberty, opportunity,

security, they all collided together, and we don’t entrust the ultimate authority to make those decisions to anybody else except politicians, politicians who are accountable to the electorate, and that’s

who—the people who are making the decisions at this exercise

were the two people who had faced the electorate, had worked with

the electorate and felt accountable to the electorate, and that was

the Governor of Oklahoma and the President of the United States.

That’s where it really belongs.

I think trying to overly engineer in isolation the solution to how

you’re going to handling a crisis when you’re in a wartime environment, this is a wartime environment, any other way would be a

mistake. Leave it to the people who we’ve empowered to be making

decisions for all of us. I felt in good company having them make

the decisions, personally.

Mr. SHAYS. Mr. Nunn.

Senator NUNN. I would just add one other thing. I do think it’s

important for this subcommittee and the full committee and the

Congress to anticipate some of these broad scenarios in determining how much authority you want to give to the President of the

United States and Secretary of Defense and others. We did that

when we passed the Nunn-Lugar legislation in 1991 on the question of bioterrorism and chemical. We gave more authority and had

some waivers of the posse comatitus statutes back then, and I’m

sure that needs updating. It was done years ago, I believe, under

the Reagan administration in terms of posse comitatus waivers,

use of military in nuclear scenarios.

But I think some of that really needs to be fundamentally

thought through here, because if you don’t have any authority, and

the first day the President has to breach what some may perceive

to be the existing law, then where’s the line after that? As hard as

it is, I think you need to try to tackle it, because when you get into

that sort of situation, any President of the United States or any

Governor is going to be asking questions; what is the law, what is

my authority? They’re going to ask those questions, and they must,

but if they get an ambiguous answer back and they don’t know,

they’re going to seize the authority when the lives of millions of

people are at stake.

Mr. SHAYS. But I’ll even say something more. Even if the law

were in contradiction to what a President’s instinct was, if the end

result was a very good decision ultimately for the survival of our

Nation, I hope to God that President makes that decision.

Senator NUNN. I think he would. I think he would need to explain it to the American people very carefully, though, and I believe

that the question of how far you were into the scenario would be

all important. The hardest thing for a President would be to take

that kind of action before the people knew there was a serious

problem.

Mr. SHAYS. I am struck in all of the work that we have done on

terrorist issues, that terrorists want to disrupt almost more than

they necessarily want to kill. I mean, the potential terrorist attack

on the tunnels in New York where you would have flames coming

out both ends, the question is, would people ever go into those tunVerDate 11-MAY-2000 10:00 Sep 25, 2002 Jkt 000000 PO 00000 Frm 00087 Fmt 6633 Sfmt 6633 C:\DOCS\81593.TXT HGOVREF1 PsN: HGOVREF1
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nels again? And what would that do to the commerce of New York?

Those kind of things have such long-lasting impact.

The Gilmore Commission, getting to Mr. Gilman’s comments

about reorganization and lines of authority and so on, advocated a

central office to coordinate a domestic response to terrorist attack,

with clear budget authority and intelligence capability.

The Hart-Rudman Commission advocates a centralized office

called the home office. Frankly, it is a term—actually the more I

thought about it, there is so much logic to it. The Coast Guard and

FEMA and so on. But it still raised a question as to what authority—still have to come to grips with what authority, budget authority, you know what kind of line authority do you have and so on.

And, Dr. Hamre, your organization has also called for centralized

coordination. In the end, would all of the panelists, if there is a disagreement here, agree that we have to have a much more centralized control with budget authority, with some line responsibilities,

with a clear—more than a drug czar, with some clear ability to dictate budgets on other departments if it relates to this issue?

Dr. Hauer.

Mr. HAUER. Yes, I think that is essential. I think that the fragmentation that we have seen at the Federal level has really hurt

the country’s preparedness. The majority of the money over the last

4 or 5 years has gone into buying toys for local governments for

chemical response, and for the lights and sirens response.

CDC and HHS in the last several years has worked hard to try

and begin to rebuild the Nation’s public health infrastructure, but

that is going to take some time.

The issues that we confront in preparing for biological terrorism

are completely different than the issues we deal with in preparing

for chemical terrorism.

I think it is very important that we have a central focus at the

Federal level that can have this overarching approach that looks at

chemical, biological, nuclear, the use of dirty bombs is a very big

concern at the local level; not nuclear bombs, but dirty bombs.

We need to have one point of contact. We get mixed messages

from various Federal agencies and have gotten mixed messages.

When I was still in my capacity in New York City, we could call

three or four different Federal agencies, the Justice Department,

FEMA, HHS, and DOD and get different training. The training

was not necessarily consistent. Different programs, different recommendations, different recommendations on equipment. And we

found it to be very inefficient and very ineffective. A lot of that is

changing. A lot of the program in DOD has moved over to the Justice Department.

But realistically this should be housed in a central location, in

my opinion, and should be in FEMA, with strong support from the

White House. And then at—the other agencies should be working

through FEMA, so that there is one voice at the Federal level, one

coordinated plan at the Federal level, and that money flows in a

coordinated fashion to the State and local governments.

Mr. SHAYS. Let me conclude just with an observation and not

to—Mr. Tierney and I agree on many things, and we sometimes

view it slightly differently.

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I have met with Ambassador Mehle on more than one occasion

in Geneva and here during the Clinton administration, and he had

tremendous reservations about the protocol, not the convention on

biological weapons.

In other words, we have a convention that we are not going to

make biological weapons. The protocol is the challenge. How do you

determine whether countries are doing it? And my observation and

my view is that the protocol would provide minimal inconvenience

to the bad guys and ladies and cause tremendous problems for

those who wanted to abide by the system in an honest way.

So I would have probably predicted that this former administration would have had gigantic questions about T. Board Post, the

Ambassador who has done the protocol. And I sense that—at least

my observation is that the policy isn’t all that inconsistent.

But time remains, and I could be wrong about it, but that is my

sense.

Mr. Kucinich, would you like us to go to the next panel? Is that

all right?

Mr. KUCINICH. Yes.

Mr. SHAYS. I don’t know, there was probably a question or two

that we should have asked that some of you may have prepared

for. Is there a question that you wished we had asked you that you

thought important enough——

Mr. HAMRE. We have a wonderful panel that is coming next. I

am not trying to get us off the stage, but you need to hear from

them too, because they are actually the first responders. If there

are questions that come to you that you would like us to answer,

please route them to us and we’ll make sure that everybody gets

them and we can answer them.

Mr. SHAYS. Any other comments? I am very grateful for you, all

of you for being here. And we’ll go to the second panel.

Senator NUNN. I would like to thank you and the subcommittee

for your leadership on this issue, not just today but going back in

the past. I think that you have really been the voice of asking the

right questions, you and the subcommittee. And I congratulate all

of you, and hope that you continue it.

Mr. SHAYS. Thank you. Very kind of you, Senator.

Our second panel is comprised of those who respond on the line.

Major General William Cugno, Adjutant General of Connecticut,

accompanied by Major General Fred Reese, vice chief, National

Guard Bureau in Connecticut; Major General Ronald Harrison, Adjutant General of Florida; Dr. James M. Hughes, Director, National

Center for Infectious Diseases, Centers for Disease Control and

Prevention, accompanied by Dr. James LeDuc, Acting Director, Division of Viral and Rickettsial Disease—sorry about that—National

Center for Infectious Disease, Centers for Disease Control and Prevention.

If I had the disease, believe me, I would learn the name.

Dr. Patricia Quinlisk, medical director and State epidemiologist,

Iowa Department of Health, and former president, Council of State

and Territorial Epidemiologists; Dr. Jeffrey S. Duchin, chief, Communicable Disease Control Epidemiology and Immunization Section, Public Health, Seattle and King County, WA.

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Do we have all of our witnesses here? And I would like to say

to my second panel, thank you for listening to the first panel.

Sometimes we have some so-called name figures. But you need to

know that this panel considers this panel of equal distinction, and

we have the expectation that we will learn as much, if not more,

from all of you as well.

So with that, I would ask you to stand and raise your right

hands, please.

[Witnesses sworn.]

Mr. SHAYS. Note for the record all of the witnesses and potential

witnesses have responded in the affirmative. And I—at this time

I thank my colleague, Mr. Kucinich, for allowing us to go to the

second panel, because we do need to get on. I don’t know if the gentleman would like to make a comment, and if not, OK.

We are going to begin with you, General Harrison. And then,

may I ask the line—right down the line this way. This is the first

time that I have ever gone that way. OK, General, you are on.

STATEMENTS OF MAJOR GENERAL RONALD O. HARRISON,

THE ADJUTANT GENERAL OF FLORIDA; MAJOR GENERAL

WILLIAM A. CUGNO, THE ADJUTANT GENERAL OF CONNECTICUT, ACCOMPANIED BY MAJOR GENERAL FRED

REESE; DR. JAMES HUGHES, DIRECTOR, NATIONAL CENTER

FOR INFECTIOUS DISEASES, CENTERS FOR DISEASE CONTROL AND PREVENTION, ACCOMPANIED BY DR. JAMES

LeDUC, ACTING DIRECTOR, DIVISION OF VIRAL AND RICKETTSIAL DISEASES, DIRECTOR, NATIONAL CENTER FOR INFECTIOUS DISEASES; DR. PATRICIA QUINLISK, MEDICAL DIRECTOR AND STATE EPIDEMIOLOGIST, IOWA DEPARTMENT

OF PUBLIC HEALTH AND FORMER PRESIDENT, COUNCIL

AND TERRITORIAL EPIDEMIOLOGISTS; AND DR. JEFFREY

DUCHIN, CHIEF, COMMUNICABLE DISEASE CONTROL, EPIDEMIOLOGY AND IMMUNIZATION SECTION, PUBLIC

HEALTH, SEATTLE AND KING COUNTY, WA

General HARRISON. Mr. Chairman, thank you, and distinguished

members of the subcommittee. I appreciate the opportunity to address you today and your continued support of the National Guard.

The United States faces a variety of global security challenges

and concurrent to these global challenges homeland security contingencies are expected to grow in significance. For the first time,

defense of the American homeland has been incorporated into the

guidelines for the American military strategy.

The threat of asymmetric attack on critical U.S. infrastructure

and on the Nation’s ability to execute war plans is credible. All

components of the United States military must prepare and be

ready for the challenge of the homeland security mission.

The great strength of the National Guard is its proven dual-mission capability. As part of the total force, the Florida Guard—excuse me, the National Guard is fully integrated and engaged in the

joint operational support contingency operations, military-to-military contact, and deterrence missions.

The training, organization, equipment and discipline developed

for the Federal mission allows the National Guard to perform misVerDate 11-MAY-2000 10:00 Sep 25, 2002 Jkt 000000 PO 00000 Frm 00090 Fmt 6633 Sfmt 6633 C:\DOCS\81593.TXT HGOVREF1 PsN: HGOVREF1
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sions throughout the spectrum of conflict, ranging from the domestic response to the full major theater war.

Homeland security has been a vital role for the National Guard

since the Guard’s inceptions over three centuries ago, and the National Guard recognizes the importance of its homeland security

role, as evidenced by the Chief, National Guard Bureau’s congressional testimony that the Guard must grant the same stature to

the defense of the homeland as the support we provide to the combat commanders.

The National Guard currently plays a significant role in the traditional homeland security missions involving response to natural

disasters and civil emergencies. In over 20 States the State Adjutant General acts not only as the commander of the Army and Air

National Guard units within the State, but also as the director of

State emergency management.

In other States the Adjutant General serves as the Governor’s

advisor for military emergency response. Regardless of the arrangement, the National Guard staffs operate in close coordination with

State and local agencies to prepare for such incidents and mitigate

their effects.

As the National Guard looks to strengthen America’s homeland,

the Guard is prepared for homeland security missions in the areas

of air-land defense, crisis consequence management. Examples of

these missions include air sovereignty, assistance to Customs authorities, Border Patrol and other agencies, identification and protection of critical assets, force protection, information operations,

military support to civilian authorities, National Guard weapons of

mass destruction, civil support team programs, facilitation of the

local, State, regional planning incident assessment and reconnaissance.

The Dark Winter exercise provided a dynamic scenario to test

the emergency response system. Although I was not a participant

in this exercise, my experience as the Adjutant General of Florida

has provided me opportunity to face crisis and consequence management involving man-made and natural disasters.

As the Adjutant General, I am the primary military advisor to

the Governor. I do not have emergency management under my responsibility. In Florida I command 10,000 Army National Guard

soldiers and 2,000 Air National Guard airmen. My soldiers and airmen provide a unique asset to the State during times of disaster.

While I cannot comment on the interplay of this exercise, I can

provide a viewpoint that reflects the challenges faced by the National Guard during a time of crisis such as this.

The National Guard is currently involved in response planning

for weapons of mass incidents such as that posed in Dark Winter.

The Guard constantly reviews its plans and the Federal response

plan regarding weapons of mass destruction or any similar incident.

At the national planning level, the National Guard Bureau is

fully involved with the Department of Defense weapons of mass destruction initiatives, and then at the State level each National

Guard is integrated fully into their State’s emergency response

plan.

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The National Guard is involved in regional planning through the

Emergency Management Assistance Compact [EMAC], a mutual

aid agreement between States that was developed to allow for the

rapid deployment and allocation of National Guard personnel and

equipment to help disaster relief efforts in other States.

Such agreements enable the National Guard to provide support

assets across State boundaries. Thus, the National Guard is structured at the national and State level to provide significant military

support to civilian authorities.

If a scenario outlined in Dark Winter occurred in Florida, the Adjutant General would coordinate, deploy and control National

Guard forces and resources to provide military support to civil authorities.

Unity of effort is crucial in these operations to ensure that the

citizens of the affected area are provided the most effective support

as there may be a requirement. For Federal military assets, the

issue of command and control of these assets must be addressed.

There have been initiatives to have the Defense Department

broaden and strengthen the existing Joint Forces Command—Joint

Task Force civil support to coordinate military planning, doctrine

and command and control for military support for all hazards and

disasters.

Deployment of such a task force may clarify the command and

control issue. There are alternatives to the deployment of this task

force to manage Federal military assets. In the instance that the

Governor has requested Federal troops without Federalizing the

National Guard, the Adjutant General can provide reception, staging, onward movement and integration, RSOI, and have tactical

control of Federal troops deployed to the State for the emergency.

This mission relationship would allow the Governors to obtain

Federal military assistance while maintaining the unique status

and capability they have through control of the National Guard

military assets responding to emergencies, a capability they would

lose if the State’s National Guard forces were Federalized.

Regardless of the ultimate command and control structure used

to employ Federal assets, all Federal, State and local assets must

support the Governor’s plan to address this disaster.

State and local officials normally have the experience, critical information and local knowledge to ensure Federal assets are properly employed.

The National Guard will continue to be the Governor’s primary

military asset to address emergencies. To improve the military support process, the National Guard supports the continued development of enhanced homeland security planning.

Given the Guard’s current missions and experience in homeland

security, the Guard should be involved in homeland security, joint

doctrinal development, joint regional exercises, tests and experimental efforts and expanded liaison and coordination with Federal

agencies.

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It is our duty to meet the needs of our fellow citizens throughout

the United States. Homeland security is the fundamental mission

of our military. The National Guard will be prepared for its role in

this mission.

Mr. Chairman, I appreciate the opportunity to address this prestigious subcommittee, and I look forward to your questions.

[The prepared statement of General Harrison follows:]

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Mr. SHAYS. Thank you, General Harrison. I appreciate your testimony. Major Cugno—General. Why did I say Major?

General CUGNO. Is there a message there, sir?

Mr. SHAYS. No message. It is insubordination on my part.

General CUGNO. Good afternoon, Mr. Chairman and distinguished members. On behalf of the nearly 6,000 men and women

who comprise the Connecticut National Guard in the State Military

Department and the over 400,000 men and women of the National

Guard, I want to begin by thanking you for the opportunity to testify and participate in these hearings on combating terrorism.

I’ll focus my remarks today on the role of the National Guard

during State emergencies, specifically Connecticut, with my experiences in Connecticut. And I’ll include biological weapons attacks

similar to the exercise Dark Winter.

As the Adjutant General of Connecticut, I am entrusted by the

Governor with the authority necessary to carry out the provisions

of our State statutes regarding the militia, the Connecticut National Guard, and the Office of Emergency Management.

I serve as the principal advisor to the Governor on military matters, emergency operations, and civil support.

As the Adjutant General, I have two main responsibilities. My

Federal responsibility is to serve as the custodian of the CICs, or

the Commander in Chiefs’ forces on the Federal side, and I must

be ready to deploy combat-ready soldiers and airmen when the

President Federalizes units.

In my State capacity as the Adjutant General, I am the senior

emergency management official for Connecticut. I exercise this authority through our Connecticut Office of Emergency Management.

Further, in May 2000 the Governor directed the Military Department to be the lead State coordinating agency in Connecticut for

counterterrorism, domestic preparedness. This, incidently, was in

response to the Justice Department’s request for such information.

Connecticut, as recently mentioned a moment ago by my colleague, along with 22 other States, has this Office of Emergency

Management organized within its State Military Department and

under the control of the Adjutant General. The OEM serves as the

principal liaison and/or coordinator to the Federal office of FEMA,

the Federal Emergency Management Agency, and our State law enforcement officials.

Further, we divided the State into five emergency management

regions. Each regional office maintains regional specific emergency

plans and serves as principal liaison and coordinator to the 169

towns located throughout the State. In order to maintain an appropriate level of preparedness, my department develops and regularly

exercises unified emergency operations plans for a number of potential State emergencies.

We maintain and implement plans for nuclear preparedness,

safety, natural and manmade disasters and civil disturbance. Next

month we will conduct our third hurricane exercise in the last 2

years in preparing to implement our second WMD exercise this fall.

In recognition of the uniqueness of each State, I offer my comments as specific to the State of Connecticut. However, you will

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sponse contingencies mirror the Federal response plan and most

States’ agencies have a role during State emergencies.

The Governor’s role is clearly outlined in both the U.S. Constitution and the General Statutes of Connecticut. Though the Governor

expects and appreciates the effort of the Federal Government in

preserving the welfare of our citizens and the infrastructure of our

communities, ultimately during emergencies it is the Governor who

is responsible for restoring normalcy to the citizens of the States.

Politically, and I think most of my Adjutant General colleagues

will agree, Governors consider the emergency response aspect of

their overall duties paramount to maintaining public confidence

and trust.

The National Guard is a unique asset to this country and we are

ideally situated and positioned to play an essential role in a Dark

Winter type scenario. Reliance on the National Guard has been a

cornerstone of American foreign and domestic policy for over 360

years. I submit to you that the National Guard has played a vital

part in executing homeland security throughout our rich country’s

history.

When missioned and properly resourced, the Guard has proven

to play a significant national asset. Accordingly, homeland security

should be seen as an additional mission, not the mission of the National Guard. As we develop our Nation’s comprehensive plan, the

Guard forces who span nationwide nearly 3,300 locations and 2,700

communities should be recognized as the existent forward deployed

military force to this country.

Additionally, the majority of States that have interstate compacts

and regional compacts will provide Governors access to additional

resources. The compacts place responding assets under the operational control of requesting Governors, thus preserving the existing incident command structure and allowing a seamless transition

into already existing emergency management structure within the

States. These relationships make the National Guard uniquely

qualified to perform a fusion role on behalf of the Department of

Defense in domestic assurances.

Though I did not participate in the exercise Dark Winter, I received detailed and candid feedback from some of my colleagues

who observed it. In their eyes, though the exercise was useful and

beneficial, it strayed from reality.

Although Governor Keating played himself as the Governor,

there was no person playing the role of the Adjutant General, who

again in 23 States commands the State Office of Emergency Management and in the majority of States is not only a key participant

during emergencies, but also keenly aware of the role of FEMA,

and will often participate through exercises and routinely practices

the State emergency plans.

During State emergencies, the Adjutant General is a key official

for the Governor, and he or she is used as a central and visible

role.

My colleagues remarked that the exercise was federally centric

in nature, and it was their belief that the scenario facilitators intentionally moved quickly beyond the State capabilities to meet the

demands of the President.

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They further indicated that it was evident from the comments of

the Federal players very early in the exercise of their desire for the

President to Federalize the Guard, and a general lack of understanding of the capability of the Guard to execute the mission.

Finally, my colleagues informed me that in defense of the scenario drivers the Federal role players found it difficult and frustrating to deal with all of the different States, their capabilities

and the various powers granted in these State statutes regarding

civil emergencies.

I can’t emphasize enough the realities of what occurs in a State

during emergencies. I know those who advocate a strong Federal

role often underestimate these realities. The Governor has the ultimate responsibility to decide to restore normalcy to his or her citizens, and should to the greatest extent resist relinquishing control.

Dark Winter proponents of a strong Federal role clearly demonstrate a lack of understanding of statehood and political realities.

I am concerned that Dark Winter is an example of an exercise developed by respected institutions which have an important influence on our government’s response plans yet fail to incorporate the

most basic realities of State emergency response and State public

policy.

I would suggest for future exercises that we include a full spectrum of core emergency response officials on all levels. This would

allow participants to exercise their plans and gain realistic experience of integrating plans at all levels.

To recap, sir, I would like to leave you with the following. The

Governor in my eyes is in charge. We must challenge adequate resources, Federal resources, to our State and local first responders

through existing emergency management centers consistent with

the Federal response plan.

State agencies possess unique skills and assets which must be integrated and included in the response plans, and further exercises

to be credible should also include existing State emergency plans

and the National Guard.

Mr. Chairman, thank you once again for inviting me to testify

before your committee and allowing a forum for candid discussion.

I am prepared to answer your questions. Thank you.

[The prepared statement of General Cugno follows:]

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Mr. SHAYS. Thank you, General.

Dr. Hughes, it is nice to have you back, accompanied by Dr.

LeDuc. Doctor, thank you.

Mr. HUGHES. Thank you, Mr. Chairman. And good afternoon. I

am accompanied by Dr. James LeDuc, who is our Acting Director

of our Division of Viral and Rickettsial Diseases. Thank you for the

invitation to update you on CDC’s public health response to the

threat of bioterrorism.

I will also briefly address specific activities aimed at improving

national preparedness for a deliberate release of smallpox virus as

simulated in Dark Winter.

In 1998, CDC issued Preventing Emerging Infectious Diseases: A

Strategy for the 21st Century, which emphasizes the need to be

prepared for the unexpected, including antibiotic-resistant infections, vector-borne diseases such as West Nile encephalitis, a naturally occurring influenza pandemic, or the deliberate release of

smallpox virus by a terrorist.

Building upon these efforts, last year CDC issued a strategy outlining steps for strengthening capacities to protect the Nation

against threats of biological and chemical terrorism. This strategy

identified five priority areas for planning efforts.

The first priority area is preparedness and prevention. CDC is

working to ensure that Federal, State and local public health communities are prepared to work in coordination with the medical

and emergency response communities to address the public health

consequences of biological and chemical terrorism.

We are developing performance standards and are helping States

conduct exercises to assess local readiness for bioterrorism. In addition, CDC with other agencies is supporting research to address

scientific priorities related to bioterrorism.

CDC, NIH and DOD are pursuing a collaborative research agenda on smallpox to improve diagnostic capabilities, identify effective

antiviral drugs and identify how the virus causes illness.

The second priority area is the critically important one of disease

surveillance. Because the initial detection of a biological terrorist

attack will most likely occur at the local level, it is essential to

train members of the health care community who may be the first

to identify and treat victims.

It is also necessary to upgrade the surveillance systems of State

and local health departments and strengthen their linkages with

health care providers so that unusual patterns of disease can be

properly detected. CDC is working with partners to provide educational materials regarding potential bioterrorism agents to the

medical and public health communities, including a video on smallpox vaccination techniques.

Third, to ensure that control strategies and treatment measures

can be implemented promptly, rapid diagnosis will be critical.

Fourth, a timely response to a biological terrorist event involves

a well-rehearsed plan for detection, epidemiologic investigation and

medical treatment. CDC is addressing this priority by assisting

State and local health agencies in developing their plans for responding to unusual events, and by bolstering CDC’s capacities

within the overall Federal bioterrorism response effort.

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The fifth priority area addresses communication system needs. In

the event of an intentional release of a biological agent, rapid and

secure communications within the public health system will be especially crucial to ensure a prompt and coordinated response. CDC

is building the Nation’s public health communications infrastructure through the Health Alert Network. CDC has been addressing

these priorities as part of its bioterrorism preparedness efforts.

The issues that emerged from the recent Dark Winter exercise

reflected similar themes that need to be addressed. For example,

the exercise highlighted the importance of working with and

through the Governors’ offices as part of planning and response efforts. It was also clear that preexisting guidance regarding strategic use of limited smallpox vaccine stocks in high risk persons

would have accelerated the response.

It was evident that effective communications with the media and

the public during such an emergency will be crucial. CDC will continue to work with partners to address challenges in public health

preparedness, including those raised at Dark Winter. For example,

work done by CDC staff to model the effects of control measures

such as quarantine and vaccination in a smallpox outbreak have

indicated that both public health measures are important.

In summary, the best public health strategy to protect the health

of civilians against biological terrorism is the development, organization and strengthening of public health surveillance and prevention systems and tools. Not only will this approach ensure that we

are prepared for deliberate bioterrorist attacks, but it will also improve our national capacity to promptly detect and control naturally occurring new or reemerging infectious diseases. A strong and

flexible public health system is the best defense against any disease outbreak.

Thank you very much for your attention. Dr. LeDuc and I will

be happy to answer any questions later.

[The prepared statement of Mr. Hughes follows:]

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Mr. SHAYS. Dr. LeDuc, I think I sometimes rename you every

time I say your name. I am sorry.

Dr. Quinlisk.

Dr. QUINLISK. Thank you.

Mr. SHAYS. I hate to tell you, but the only way that I am going

remember that name—never mind.

Dr. QUINLISK. Don’t feel bad, almost everyone has trouble with

it.

I am very honored to appear before the subcommittee today. The

comments I will be providing are from the perspective of a State

public health official. I would like to begin with the concluding

points of my written statement.

No. 1, public health needs to be seen as a major player and as

having expertise and as needing therefore to control some aspects

of bioterrorism preparedness response. Thus, public health needs to

be at the table.

Two, the detection of disease, laboratory identification, investigation of outbreaks, response and rapid secure communications are

all critical but underresourced. These systems are all multi-use and

once installed will be used daily for more common situations as

well as preparing us to respond to deliberate acts.

Allied fields such as a laboratory, veterinary, medical and mental

health fields need to be assessed and their appropriate involvement

addressed. Communications are critical between public health entities with other emergency response agencies and with the public.

I have been asked to address some of the public health issued

identified during the Dark Winter exercise. Even though I was not

part of Dark Winter, I have talked with people who were and have

been part of similar exercises in the past.

Public health issues that have become apparent during these

events include issues surrounding legal authorities and abilities,

communication with other public health entities, emergency officials and the public and coordination with the others who are involved in the emergency response.

Legal issues include those surrounding quarantine, both at the

individual and at the community level. Under what authority is it

instituted? If different States implement quarantine differently,

does the Federal Government arbitrate such issues as who is allowed to break the quarantine?

Also in these days of foot-and-mouth disease, we need to consider

animal and agricultural quarantine.

Communications and coordination concerns arise because, in

part, public health has only been a minor player in the past. For

example, I understand that during Dark Winter there was an early

request for the number of people who had been exposed to smallpox

when public health officials were just beginning their investigation

and had not yet determined this.

I have also found that during these exercises when medical and

scientific information is requested, it is often delivered in a context

not easily understood or used by those nonmedical people in command. Coordination and communication between these groups is

improving, but I believe we have a long way to go.

With regard to State-Federal interaction, those of us who are

working in bioterrorism in the States, our main Federal partner is

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the Centers for Disease Control and Prevention, the CDC. Almost

all Federal funding to the State public health preparedness comes

through the Centers for Disease Control. Also the CDC provides

guidelines, training, communication and laboratory support.

Very little contact or support comes from any other Federal agency. Within the last few years, great progress has been made to create State-to-Federal secure communications and alert systems such

as EPIX and the Health Alert Network. Electronic reporting of

cases of disease from States to CDC is also improving through the

recent and ongoing implementation of the National Electronic Disease Surveillance System, but these systems need to be expanded

to ensure the communications can be timely, effective and secure.

Even with rapid electronic reporting and analysis of disease occurrence, public health still relies heavily on the medical community to tell us what they are seeing. However, this means public

health must become more visible and better linked to the medical

community. I believe the communications between all responders

and with the public will be a major issue in any terrorist event.

As stated by CDC’s guidelines, effective communications with the

public through the news media will be essential to limit the terrorist’s ability to induce panic and disrupt daily life.

Many of us in public health are concerned not only about the

health impact of these diseases themselves, but of the psychological

impacts, both during and after an event. In my opinion, mental

health experts need to be at the table during exercises and incorporated into State and Federal emergency plans.

Within the public health system, the laboratory is critical. Public

health laboratories must be able to quickly identify or rule out any

organisms potentially involved and to communicate those results to

the appropriate medical and public health authorities.

Federal funding being distributed by CDC is helping to address

these issues, but again more needs to be done. Also veterinary laboratories need to be integrated into the bioterrorism surveillance

system.

As a member of the Gilmore Commission, I have been asked to

comment on its findings and recommendations. One of its major

recommendations is the need to focus more on the higher-probability, lower-consequence situations rather than the lower-probability, higher-consequence ones. This results in more focus at the

State and local preparedness level.

Finally, I would like to state that continuing to build toward a

robust, comprehensive public health system, we will be building a

multi-use system that will be used for more common diseases and

situations every day. Thus, when a terrorist event occurs the system will be well-tested, effective and familiar to those who are involved.

Thank you for the opportunity to provide testimony to you on

this very important matter. I will be pleased to answer any questions.

[The prepared statement of Dr. Quinlisk follows:]

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Mr. SHAYS. Thank you, Dr. Quinlisk.

Dr. Duchin.

Dr. DUCHIN. Good afternoon, Mr. Chairman, members of the

committee. Thank you for this opportunity to speak on the role of

public health professionals in responding to a biological weapons

attack. Because the initial detection of a biological weapons attack

will occur at the local level, a primary role for public health is the

detection and investigation of illnesses compatible with a biological

weapons attack.

Once a potential biological attack is detected, a public health investigation would follow to confirm the event. In a suspected or

confirmed biological attack, public health professionals must determine the location and magnitude of the problem, identify the exposed population in order to target prevention and treatment, and

monitor the extent of the outbreak.

In order to limit the spread of disease in the population, public

health investigators must identify for treatment or quarantine persons exposed to biological agent.

Currently, many public health agencies are functioning with the

minimum amount of staff required to perform routine day-to-day

operations with little reserve capacity to respond to naturally occurring communicable disease outbreaks of modest scope.

An effective response to a biological weapons attack requires a

strong public health capacity at the local and State level, including

advanced surveillance system architecture and information management technology. Improvements in surveillance and information

systems are necessary to improve communications between health

departments and hospitals, laboratories, emergency management

and emergency medical systems.

For example, local public health professionals were concerned

that our usual surveillance system would not rapidly detect a biological weapons attack during the 1999 World Trade Organization

Ministerial Conference in Seattle.

Current disease surveillance relies on reports of laboratory confirmed diseases submitted from health care providers and laboratories, with a time delay associated with both the identification of

the agent of disease and the processing of reports.

To enhance our ability to detect a potential biological weapons

attack, assistance was requested from the Centers for Disease Control and Prevention for design and staffing of a special syndromic

surveillance system that once implemented the enhanced surveillance system allowed us to monitor clinical visits to area emergency departments on an around-the-clock basis.

After the conference, the enhanced surveillance system was dismantled. Ongoing optimal detection of potential biological weapons

attacks will require sustainable improvements in surveillance systems architecture and methods.

The second major role for local public health professionals is to

facilitate the medical response to a biological weapons attack. This

includes assuring evaluation, treatment, and preventive measures

for the exposed population, including possible mass vaccination and

delivery of appropriate resources to local health care facilities.

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partments and public health departments, not the traditional first

responders such as firefighters and law enforcement.

Local medical systems will be rapidly overwhelmed with the response to a biological weapons attack. The ability of health care institutions to respond to unanticipated increases in the numbers of

patients with communicable diseases associated with even a relatively small naturally occurring outbreak is limited.

Prioritization of the delivery of Federal resources is needed to effectively engage health care facilities and medical professionals

with public health departments in planning and response activities

for a biological weapons attack.

A third key role of public health is to provide accurate, reliable

information to local, State and Federal agencies, medical professionals and political leaders and the public.

In summary, public health professionals, along with local health

care institutions and medical professionals are the front line responders to a biological weapons attack. Key roles for public health

include detecting, describing and monitoring the course of a biological weapons attack, assuring an adequate community-wide medical

response and providing needed information and effective communication to all parties involved in response activities and the public.

Improvements in our ability to effectively respond to a biological

weapons attack are needed and can be achieved by strengthening

public health surveillance and epidemiological capacity and

through enhancing information and communication systems at the

local and State level. Effectively engaging the medical community

in biological weapons response planning should be given high priority.

Thank you for the opportunity to testify today.

[The prepared statement of Dr. Duchin follows:]

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Mr. GILMAN. Mr. Chairman.

Mr. SHAYS. First, let me just thank Dr. Duchin and all of the

panelists.

Yes, Mr. Gilman.

Mr. GILMAN. If I might just interrupt. I regret the interruption,

but I did want to introduce a group that you and I have both met

with earlier today. These are graduate students from NYU Wagner

School, Graduate School of Public Service. They are in our back

row here. They are from Japan, Taiwan, Peru, Mozambique, and

they are here studying public administration,and I would like to

welcome them to our committee.

Mr. SHAYS. Thanks. I would like to welcome them. Some of them

smiled when you said I addressed them. I hope to have the opportunity after this hearing to visit with them.

Mr. GILMAN. Thank you, Mr. Chairman.

Mr. SHAYS. Mr. Tierney.

Mr. TIERNEY. Thank you. Well, in keeping with the desire to be

able to spend some time and get this over, I only have a couple of

brief questions.

Dr. Duchin or Dr. Quinlisk, perhaps you can answer that. What

would you assess the current training level of medical personnel,

local medical personnel for identifying these types of incidents and

for what they are, recognizing what they are and for setting a

course of action immediately at the local level?

Dr. Duchin. I’ll take a crack at that. I am in addition to the communicable disease officer a physician on the faculty of the University of Washington in the Infectious Disease Department, and I can

tell you that there is no formalized training currently for health

care professionals in the medical field to recognize agents of biowarfare. We have tried to raise the awareness of health care providers, physicians and nurses in our community using public information, Intranet, newsletters and so on. But the key I think is that

this needs to be institutionalized so that trainees receive this information as part of their formal medical education.

Mr. TIERNEY. Would you focus that on training medical students

as they come through school and on other medical personnel as

they get retraining or take courses at that time, or would you separately, alternatively or in addition train health agents in different

communities?

Dr. DUCHIN. Did you say health agents?

Mr. TIERNEY. Health agents.

Dr. DUCHIN. I think it is all. You can’t start too early. It is important to raise the awareness at the medical student level and to

reinforce the message throughout the training period, as well as

reach those who are out of training and currently in practice in the

community with continuing education.

Dr. QUINLISK. I would like to make another point there. We talk

about identification of it, but the identification will do no good if

it has not been reported to somebody, and one of the biggest problems that I see is not that somebody recognizes a disease but they

remember to pick up the phone and tell someone about it. So I

think there is two things there that we need to do training on.

Mr. TIERNEY. To train them who to contact. That would be somebody at the CDC or something like that?

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Dr. QUINLISK. Usually the local health department would be the

appropriate person to respond and then it goes up the ladder, and

that communication works quite well. It is the getting from the

health care practitioner into the public health system where I

think the biggest barrier is.

Mr. TIERNEY. How important do you think it is that people within the health profession, probably the health departments of these

areas, learn to deal with the media in a situation like this? I can

see where a situation gets totally out of hand because somebody is

inexperienced dealing with the media, because they are going to

come down like locusts once there is any hint of this type of information. And how would you recommend that we deal with that

issue?

Dr. QUINLISK. I can speak a little bit about—the scenario that I

think would be best when dealing with any kind of either potential

bioterrorist or outbreak of any kind is do whatever you need to do

to make sure that all of the messages are consistent, that they are

very clear and they are presented to the public in language that

they can understand.

What I would envision in something like this would be the Governor standing in front of the microphones with the appropriate

people behind him or her to then step up to the microphone when

appropriate questions were asked.

That way everybody in that room, every message going out to the

media is consistent and clear. I think you do great damage to public confidence if you start giving conflicting information that is not

clear.

Mr. TIERNEY. Thank you very much.

Mr. SHAYS. I thank the gentleman. Mr. Gilman.

Mr. GILMAN. Thank you, Mr. Chairman. I regret that I was with

our graduate students in the outer room, and I just have one major

question.

We addressed the last panel with this question. Since it is a troubling issue, and since we have done very little in preparation for

it, let me ask this panel. Who do you think would be the best comprehensive agency to handle this matter in our Federal Government structure, and to be effective? I ask that to the whole panel.

General.

General HARRISON. Yes, sir. I would be glad to take that one on.

I heard the other panel. And I believe that FEMA, in the configuration that has been proposed, certainly has a lot to offer there, and

I would say that for a couple of reasons.

One, the operation of FEMA in the last 8 or 10 years, particularly since Hurricane Andrew, where we had a lot of difficulty of

coordination of State agencies and Federal agencies, has come a

long way.

I think that the fact that they are organized already into emergency support functions at the Federal level to coordinate agencies

of the Federal Government, and that most States are now organized in a like manner, emergency support functions in the State

that will track what FEMA does, as they coordinate Federal and

State agencies together, really lends a lot of credibility to FEMA

having this kind of organization that is already in play.

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Perhaps there are better models. But for right now, to start

today, I would envision, because of the emergency support functions, this would be the best.

Mr. GILMAN. They would need a lot of training on this issue, I

take it?

General HARRISON. They would, sir. But I believe that there is

a model that is still good for this. The catastrophic emergencies

that have been had, where the coordination is still required, it may

not be the same requirements in terms of chemical or biological

warfare, or chemical or biological incident. But the model is still

the same and the coordination is going to be the same, and things

are in place today to do that.

Mr. GILMAN. General, did you have something further to add?

General CUGNO. Yes, sir, I do. I, too, would agree with FEMA.

Recently with the establishment of the Office of National Preparedness I think it is a move in the right track within FEMA.

Second, I think there is a proven track record of the Federal response plan. I think we have organizations like the Adjutant Generals Association, the National Guard Association, the National

Emergency Management Association that would support that, with

a central organization to deal with the consequences.

And I am not suggesting the law enforcement crisis side of this,

but simply the consequence side of it. It is a familiar program,

practice, programmed and resourced.

To answer the second part of your question, with the training,

I think part of the requirements of the future deal with the training aspects and resources necessary for training.

On the previous panel there was a gentleman here that mentioned the sirens and whistles and bells at the first responder’s portion. I think that there is some truth to that. We are talking about

the strategic level of planning at the national level. It has got great

impact on what States could expect and how they would report. So

FEMA is the answer as far as we are concerned.

Mr. GILMAN. Before leaving our two Generals, has the military

engaged in preparation for biological warfare and chemical warfare,

in preparation for our national defense?

General HARRISON. Yes, sir. I speak for the military as from the

National Guard perspective. We are, and I know that you know the

civil support teams are engaged in this, in most States. Not most

States yet, but 10 States, I think there are now more than 20, that

are engaged in this with civil support teams and are in training for

this.

In addition to that, I think the majority of the States would like

to or are doing planning for their contingencies in case something

were to happen in their major metropolitan areas, and certainly we

are in Florida, and I think that most of them are anticipating a

contingency.

Mr. GILMAN. How about Connecticut, General Cugno?

General CUGNO. Yes. I think from the basic standpoint of soldiering skills, you would also find that chemical, biological and radiological training remains a basic core part of every soldier that

jumps into uniform. That is not unique in Connecticut, that is part

of the Department of Defense requirements for the basics of soldiering skills.

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Mr. GILMAN. Dr. Hughes.

Mr. HUGHES. Yes, I agree also with FEMA in the leadership role.

We in public health have a long history of working with FEMA in

the context of their response to natural disasters to help them deal

with infectious disease issues that inevitably arise, And I would see

us continuing to do that in this area of bioterrorism by providing

expertise and advice and diagnostic patient management and treatment.

Mr. GILMAN. Dr. LeDuc.

Dr. LEDUC. Yes, sir. I agree with Dr. Hughes.

Mr. SHAYS. Good thing.

Mr. GILMAN. Dr. Quinlisk.

Dr. QUINLISK. I think what I would rather do is address whoever

it is that is put into authority over this issue. One of the things

that I would want to make sure that they are very aware of is it

not going to be business as usual. Biological attacks act very, very

differently than a hurricane, an explosion, a chemical spill. And

whoever it is that deals with it has got to understand that and not

think, oh, I can rely on my old methods, the usual way of doing

things, and that is going to be good enough, because it is not.

Mr. GILMAN. Thank you. Dr. Duchin.

Dr. DUCHIN. I agree with the previous panelists that if FEMA

does take over this role, they will need to work closely with HHS

and others who have expertise in the management of biological

issues.

Mr. GILMAN. I thank our panelists. Thank you, Mr. Chairman.

Mr. SHAYS. I thank the gentleman.

When I was listening to you, General Harrison, it seemed to me

that you were making a strong statement for the role of the Guard

in homeland defense. And, General Cugno, I heard from you that

joint exercises to, quote-unquote, fight as we train are absolutely

essential. That was one of the key points I heard from you.

And, Dr. Hughes, that surveillance and communication are absolutely vital.

Dr. Quinlisk, I heard from you something that surprises me in

a way because it seems like we wouldn’t have to say it, but it is

the sad fact that you were saying that public health is a key player

and should be at the table. And it is like, you know, what does it

take? Do we need to slap ourselves around here? You are clearly

an essential role here. You are going to hopefully make the bomb

harmless ultimately.

And Dr. Duchin, the message I heard from you is that State

health care needs help, money and training, and that was kind of

the message that I was hearing from all of you.

I then said, you know, well, you all are first line defenders. But

I thought, where are the police, the fire, and so on? When I was

asking the staff why both of you, you know, the military and the

health care, why not all of the others, they may want to jump in

because I may not have heard them correctly, but basically that

your roles are still unclear to some, and that they need to be. Obviously, you know, the police are just going to respond. I mean they

are going to respond.

And so the reason, at least from my staff’s standpoint, is that

central roles of both the military and health, but truly trying to see

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how you fit in when you have to take charge over local activities

and so on, and so in that perspective is a little clearer to me why

this panel is comprised the way that we are.

General Harrison, your office recently produced what my staff

says is a very—they don’t pass this out lightly—a very thoughtful

analysis of national security roles for the National Guard, and I

would like you to describe the issues you raised and the recommendations that were made in here. I want to give you an opportunity to just briefly talk about this if you would like. And if

I could, I would just ask unanimous consent that this white paper,

National Security Roles for the National Guard, by Colonel Michael

Flemming and Chief Warrant Officer Candace L. Graves be introduced into the record.

[The information referred to follows:]

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Mr. SHAYS. I just want you to know that our staff thought that

they did a very thoughtful job. Just give you an opportunity to

mention it.

General HARRISON. Thank you, sir.

Mr. SHAYS. Would you like to make any comment about this report?

General HARRISON. I would. I think that as a State we felt like

we needed to come to grips with what we had been talking about

and putting on paper regarding the response that we would give

to any weapons of mass destruction or biological, chemical or radiological or certainly bombing.

But to really look at biological particularly, how would we do

that, and what is different than we—that the doctor just mentioned, that is certainly different than what we would do with a

natural disaster in many cases, in most cases. We put that together, realizing though that the model that we use for a catastrophic event still has some basis for us to begin our work, very

hard to train for some of these biological incidents in the field, and

recognizing that they can go beyond State lines, and we would have

a lot more coordination to do. And it raises to—it escalates to a

Federal level.

The key points of our paper were this: That the National Guard

is in support of our local authorities, working under the Governor’s

plan. That may escalate beyond that, but initially we are going to

be tasked with supporting the local authorities under the direction

of the Governor.

And many times people feel like the Guard is only in the law enforcement area, and we get into posse comitatus and all of the

other things. And I would like to tell the committee, the subcommittee, that I was the Adjutant General when we had Hurricane Andrew, a totally different perspective than we would have in

most natural disasters. But when we did that, the Florida National

Guard stayed on active duty under the Governor, and the Federal

response from the military brought 23,000 Federal military into the

State. And it worked because we all worked under the Governor’s

plan and tried to do what the Governor thought was the right thing

to do in his State.

And that is for me the key. And it is not all—and our paper was

trying to describe that—it is not all law enforcement. There are a

whole lot of things that the Federal military can do when they

come in to help us or the Reserve and other State Guards besides

worrying about the security: Food delivery and recovery of contaminated areas and testing of water and water purification. And there

are just a whole lot of these, shelter management and search and

rescue, language support, and the list goes on.

So I think it is instructive for us to recognize that there are a

lot of things that the Federal military and the State military can

do, but is it all done under the direction of the Governor’s plan and

what he needs to get accomplished. That would be a very quick

summary, sir, of our paper.

Mr. SHAYS. Thank you.

General Cugno, what do you see—first, let me say to you, I appreciated that the Connecticut Department of Emergency Management helped the Table Talk Exercise in the Greater Bridgeport

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Area. We did a chemical—basically an attack on an Amtrak train

and what happened to the first responders and all of the challenges

that we encountered, and health care showed up right away, because everybody had all of this fancy equipment and health care

providers had a black telephone.

You know, it is like weird, the difference. And you—and I think

health care providers are in my judgment the stepchild here. I

mean, they just would know that—no reflection on step-children actually—but not given the attention that they need.

So I thank you for being part of that funding, but what do you

see are the advantages of a State Adjutant General also exercising

control over the emergency management functions?

General CUGNO. Clearly I see a great advantage, at least in our

State, having experienced both sides of this. We reorganized on

July 1, 1999, where the Adjutant General became the responsible

agent for the Office of Emergency Management.

Mr. SHAYS. Was that a State—— General CUGNO. Yes, sir. It was legislated and signed into law

by Governor Rowland. It was based upon—there had been a move

across the country. I think there were some that were going to

that. It provided the resources in our particular case in one building, close proximity to the Capitol. But it also gave all of the emergency operations that had been previously put together by the Military Department a clear focus on a direction that the Governor was

looking to go, and it was to minimize time and maximize resources

to affected areas as quickly as we possibly could.

Our experience with the FEMA folks was incredible, and it’s

worked quite well. I am very comfortable with it. The Governor is

very comfortable with it. And we find that in emergency operations

such as this, we’re able to interact with the Fed side because of the

existing Federal response plan, where there is a Federal coordinating official, there’s a State coordinating official, and those are designated individuals. Additionally, there are liaison people from

other branches of the service.

There are parts that are missing that still require attention, and

the Adjutant General’s Association is clearly aware of them and

has worked to this end. Part of it is under the new program mandated by the President with the National Preparedness Office’s

part of the FEMA, how that will integrate with the States and how

it will integrate also when resources are deployed from the Commanding General of civil support, General Lawlers’ forces, when

they come into a State and how they’ll be—whether the State is

currently under the control of Emergency Management by the Adjutant General or by a stand-alone agency, how it will integrate

Federal resources, how it will integrate the Commanding General’s

forces and other resources that he brings with it, whether active

component or reserve component.

The National Guard Bureau, we believe that’s not part of the

State but part of the Federal entity in Washington here at the

Readiness Center and at the Pentagon.

One of the reasons I had asked General Reese—and discussed it

with him—to come is that at some point, if the Congress would

like, we are prepared to provide to the Congress—it’s a one-page

brief sheet, and it follows a model that Congress has authorized in

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the counterdrug program on how we take this complex issue of

Federal rights, State rights and resources, and come up with suggestions to better minimize overhead, minimize bureaucracies, and

get resources to the front. We’re prepared to do that when you’d

like.

Mr. SHAYS. Thank you, General.

Dr. Hughes, the—I’d like to know what is being done to improve

the electronic reporting of disease between local and State governments and between States and the Federal Government. Let me

just preface it by saying what became very clear to us early on

when we started to do this work on biological threat, pathogens

and so on, is that particularly in our larger cities, we are continuing monitoring to see if there is an outbreak of both natural causes

or man-made, and so how we report this information, the fact that

we report it and so on, is I think obviously of key interest. Maybe

you could respond to it.

Dr. HUGHES. Thank you very much for asking that. It’s a very

important question, and I think Dr. Duchin and Dr. Quinlisk would

like to add something to what I have to say too. But to digress for

a moment——

Mr. SHAYS. You may digress.

Dr. HUGHES [continuing]. Let me point out that in a Dark Winter

scenario, you don’t want to rely on electronic reporting to pick that

up. It’s absolutely critical there that you have the alert health care

provider who’s trained and prepared—you want to recognize that

first case. You don’t want to, as in the scenario, after there are 20

or 30, somebody figures out that something’s going on. You have

to get the first case and that will require more conventional but

rapid communication.

Mr. SHAYS. But it’s been in the incubator for 8 or 9 days; in other

words, the disease hit over a week before.

Dr. HUGHES. I’m sorry?

Mr. SHAYS. The disease hit over a week before in terms of smallpox.

Dr. HUGHES. The exposure—yes, that’s—when you think about

infectious diseases, as you know, we have this period called the incubation period from onset——

Mr. SHAYS. That will vary depending on the disease?

Dr. HUGHES. It will vary depending upon the disease, and for

smallpox it’s typically 10, 12, 14 days. If you have a common exposure, as I suspect was the case in Dark Winter, you want to get

that case. You want to get it confirmed. You want to alert the

health care community to the fact that they see additional cases,

and that’s where some of the electronic notification can come in.

Mr. SHAYS. But that first case isn’t necessarily the first hit. I

mean the incubation could be different.

Dr. HUGHES. True.

Mr. SHAYS. So that person could end up being in a town that

wasn’t where they were exposed.

Dr. HUGHES. Yes, exactly. But you want—you want a health care

provider who sees somebody who’s sick with a febrile illness that’s

beginning to develop with a rash, you want them—in the current

climate, you want them to be sensitized to the fact that this could

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possibly be something very bad and they need to then move rapidly

to ensure that confirmatory diagnosis takes place.

That was one thing that I was happy to hear occurred in Dark

Winter, but you should not take that for granted, the recognition,

the notification, the shipment of specimens, the receipt by people

who are trained, who have containment facilities they can work in

and modern molecular tests that they can do.

So all of that is absolutely critical, but you want to get that first

case, so when you get a second or third case, you then go back and

get, as Dr. Hamburg had said, you get the histories and you see

what these people had in common so that you get that exposure,

that common exposure nailed down right away.

I think you could see how that might have helped in the management of Dark Winter. It might not have, but I would argue that

it probably would have.

Now, electronic surveillance and notification, it needs to go both

ways from local to State to Federal and back. There are efforts currently around, what we call the National Electronic Disease Surveillance System, a standardized approach to surveillance of infectious diseases and other diseases occurring in the United States

that we are making an investment in. There’s a tremendous

amount of work that needs to be done to make this a reality, however.

The other piece of this was alluded to by one or two of the previous speakers, and that is a system that’s now in place called

EPIX that would be extremely valuable I think in a Dark Winterlike scenario. This is a secure communication network linking us

at CDC with Dr. Quinlisk and her colleagues at the State level,

and Dr. Duchin and colleagues at the local public health level,

where information or late—just breaking information on outbreak

scenarios can be rapidly shared in a secure manner with people

who need to know about it.

So a lot of work needs to be done there. It’s critically important.

Mr. SHAYS. I saw a nodding of the head, Dr. Quinlisk. Did you

want to say anything or just report that you nodded your head?

Dr. QUINLISK. I would just second everything that Dr. Hughes

said, and I think we’re doing a very good job from the State to Federal level. Things are coming along, we’re working on it.

The biggest problem I see is from the local to the State level.

We’re still back 20 years ago in many States. In my own State, I

still get our own public health laboratory reporting to me by pieces

of paper they send through the mail.

Mr. SHAYS. My staff said yikes. Is that what you said?

OK. Let me kind of bring this panel and hearing to a close by

just asking—I’m a little concerned. This is such an open-ended

question; so maybe you could be selective in what you would respond to, Dr. Quinlisk or Dr. Duchin. What constraints confront

health care professionals to adequately prepare for catastrophic

events? If you could just give me the key constraints.

Dr. DUCHIN. I think, speaking as an ex-emergency department

physician and a current practitioner in infectious diseases, I think

resources, I think health care providers and health care institutions don’t feel that they have the time to devote right now for preVerDate 11-MAY-2000 10:00 Sep 25, 2002 Jkt 000000 PO 00000 Frm 00198 Fmt 6633 Sfmt 6633 C:\DOCS\81593.TXT HGOVREF1 PsN: HGOVREF1
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paring for this issue. They are constrained by their own financial

needs.

Mr. SHAYS. Financial needs, just the workload—— Dr. DUCHIN. Their workload. They need to—their income. They

need to see patients and take care of the bottom line, and I think

what we’re asking them to do is something—an unfunded mandatetype of issue where we’re asking them to train for something that’s

new and different. We’re asking them to learn a new body of

knowledge, and then to integrate a system that’s going to implement a response without giving them any resources with which to

do that.

Mr. SHAYS. I’m—you all didn’t participate in the Dark Winter,

but I’m just struck by the fact that we are woefully unprepared on

the health side. I feel like the—there are lines of authority questions for our Adjutant Generals, but on the health care side it’s

just—it clearly, I think, of all the things that I’ve thought about

today—I guess I’ve learned a lot, but I’m most concerned about

startabilty, particularly in a case like smallpox, to just respond.

Dr. Hughes, maybe you could just comment on the stockpiling,

I mean the 12 million, for instance. Are we going to have to just

really reassess our stockpiling issues?

Dr. HUGHES. Well, let me focus on just the smallpox vaccine component of the stockpiling, and Dr. LeDuc is much more familiar

with the details of this than I and he will want to chip in here.

There are actually about 15 million doses of vaccine available.

Mr. SHAYS. How many?

Dr. HUGHES. About 15 million.

Mr. SHAYS. Which isn’t a lot.

Dr. HUGHES. No, it’s not a lot. And we would like more and Dr.

LeDuc can talk about some of the specifics in terms of how we’re

moving to have more produced.

Mr. SHAYS. It lasts about 10 years, the vaccine?

Dr. HUGHES. Well, the shelf life is probably even greater than

that. Let me just——

Mr. SHAYS. I’d like you to respond, Dr. LeDuc, but what I’m

being told is this is a vaccine that as long as the symptoms haven’t

appeared the vaccine has impact, but once the symptoms appear— but it can spread before the symptoms appear. No or yes?

Dr. HUGHES. No. No.

Mr. SHAYS. So that’s the good news in the sense—in other words,

it’s not being spread before the symptoms show up?

Dr. HUGHES. Right. Dr. Henderson, if he were here, would say

from his experience which was extensive, obviously, administration

of smallpox vaccine within 3 to 4 days after exposure would prevent illness.

Mr. SHAYS. So the biggest incentive in this case would be just to

give as many people the vaccine as possible?

Dr. HUGHES. But given the fact that we’re always going to be

constrained in the amount of vaccine available, you want to be sure

you’re targeting the vaccine to——

Mr. SHAYS. Because we’re under a scenario where we have limited supply. But I could even see a scenario where you would have

a world supply and you’d ship it by Concord jet if you had to, but

you’d get it quick.

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Dr. HUGHES. Yes. And I think there are a lot of countries who

would like that. But the current vaccine and the second generation,

as was pointed out, does have some side effects. So you have to be

cognizant that there is some risk—— Mr. SHAYS. Well, all vaccines have side effects.

Dr. HUGHES. Yes, but smallpox vaccine probably more than others.

Mr. SHAYS. We won’t get to anthrax. We won’t go there.

Dr. HUGHES. We don’t have time.

Mr. SHAYS. OK. Doctor.

Dr. LEDUC. Thank you. Dr. Hughes asked me to come just to

give you—be available for a brief update on the actual—— Mr. SHAYS. He wanted moral support.

Dr. LEDUC. Well, and I’ve done my best, although I feel a little

bit like the party crasher in the middle of the table and not saying

anything.

Mr. SHAYS. My feeling is this. The one who speaks the least

probably has more time to think about the answer. So I’m expecting a really good answer.

Dr. LEDUC. Thank you for the added pressure. I think you’re familiar with the contract in place. There are a couple of important

issues. No. 1, this is a new vaccine from the regulatory perspective.

It’s a whole new manufacturing process. So there are going to be

some hurdles to overcome, and we’re already seeing some of those.

No. 2, we have designed this contract so we have a sustained capacity to make the vaccine over a long period of time. The contract

actually extends through the year 2020; so we have estimated a 5-

year shelf life. We’ve projected replacing that. We’ve also projected

that vaccine would accumulate so at the end of the 20 years we

would produce a total of something like 160 million doses. The idea

is to have 40 million doses on hand as quickly as possible.

To make a vaccine, this particular vaccine, there really are two

parallel tracts that we have to follow. No. 1, just the nuts and bolts

of how do you make that; and, No. 2, the regulatory side, does this

vaccine do what we expect it to do in protecting people?

On the nuts and bolts, making the vaccine, we are I think in

very good shape. We begin vaccine lot production next month. That

should be done in about 2 months, and that will be used for the

initial safety trials.

As soon as that production is finished, we will then begin making

three full-scale manufacturing production lots, and that will be

done toward the end of the next year, about October 2002. At that

time, we’ll have the capacity to make the vaccine.

Each lot is a little over 3 million doses. It’s about 3.3 or 3.4 million doses per lot. We can make roughly one of those per month,

if pressed. We could scale up that. This is all limited, by and large,

by equipment. If we wanted to double that, we’d just buy more

equipment. We can do that.

On the human side, proving that vaccine actually works, that

will require formal testing. And we’re working very closely with the

FDA to set those tests up, and in fact we meet with them on August 15, next month, to have what’s called a pre-IND meeting. This

is the first formal meeting to tell them what we’re going to do. We

then hope to file the IND in October or so.

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As I mentioned, we’ll go through the phase I safety trials. Those

will start actually in December of this year and will take about 4

months to be completed. Then we’ll go into the phase II and phase

III safety and efficacy trials, and those will take about 3 years.

They should be done in October 2003 and then we’ll file the licensing. So, early 2004 we should have the licensed product.

Mr. SHAYS. Thank you. If you think it is an exercise without a

need, then it becomes an exercise without a need. But if you think

there is the real possibility that there could be an attack like this,

every minute that you spend on this issue is extraordinarily valuable, and that’s kind of where I come down.

I just want to invite any of our witnesses to—any of you, to ask

yourself a question that we should have asked, and answer it if

you’d like to. Is there—otherwise we will just conclude there.

General, is there a question that you wish we had asked or we

should have asked?

Mr. HARRISON. Well, I would maybe just a reiteration, sir, part

of what I have said. The reason that the National Guard is capable

of doing what is needed to be done is because we’re organized and

trained and equipped and disciplined to do the warfighting anywhere in the world speaks clearly for me to the fact that this is

a mission for us, but it is not the primary mission. We need to stay

in the warfighting business to be able to do this as we do now.

And the last is that it’s very important that we recognize that

Federalization of the National Guard is probably not the way to do

things—I would never say never—but not the way to do things,

and that the flexibility—and really I would say this. There’s a synergistic effect. If and when the Federal military has to come in and

work and the State National Guard is still on State active duty,

there’s a synergy that is created to really get more work because

of the missions.

Mr. SHAYS. I should have made that point. That point came

through loud and clear, and I think it needed to be emphasized,

and I thank you for that.

Dr. HARRISON. Thank you, sir.

Mr. SHAYS. Major Cugno. General. Gosh, I don’t—I’m a bad speller. I see MG and I think Major. I know it’s MG but——

General CUGNO. Sir, the only thing I would like to leave you with

is in every State there’s an emergency plan, the Governor is actively involved with it. That emergency plan is existing, it’s practiced. Regardless of what the catastrophe is, the consequences of

that catastrophe may have been planned for. It integrates law enforcement officials, medical facilities, medical assets and resources,

in addition to the National Guard and the resources. In every

State’s compact, it gives the commander or Governor the ability to

reach out and touch additional assets, future operations,

plannings—and exercises at the Federal level have to recognize

that.

I think if not, we really don’t get an accurate picture of what the

consequences or abilities are of a State.

Mr. SHAYS. Thank you, sir. Anybody else? Dr. Hughes or anybody

else?

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Dr. HUGHES. Well, I would say briefly in this context of bioterrorism, prevention is critical. If that fails, early detection and rapid

response in a coordinated way is critical.

And then I’d like to just end by acknowledging what a number

of people pointed out in the previous panel. This lack of surge capacity is a critical issue whether we’re dealing with naturally occurring disease, the annual influenza epidemic, let alone a flu pandemic on the one hand or a bioterrorism—— Mr. SHAYS. That suggests government intervention to allow for

that surge capability, doesn’t it?

Dr. HUGHES. Pardon?

Mr. SHAYS. It suggests government intervention to—certainly the

stockpiling would be at government expense.

Dr. HUGHES. Well, there’s certainly a need for government leadership and investment, yes.

Mr. SHAYS. Are you suggesting that there may be imaginative

ways to—when you say surge capability, that tells me we need to

have excess supply.

Dr. HUGHES. We have—no.

Mr. SHAYS. No need to have extra supply, additional supply, that

you wouldn’t think you would need on a day-to-day basis?

Dr. HUGHES. Well, yes. I mean it comes up in the noncontext of

the health care setting, just beds for patients. You know, each year

there are hospitals that close during the influenza season. We’re

faced with shortages and delays in vaccines, as you know. We have

shortages of some antibiotics, even including penicillin. Who could

think that would happen in the United States?

Sometimes we run into problems of shortages even with diagnostic tests. So that’s the point.

Mr. SHAYS. Anyone else?

Dr. QUINLISK. I would just like to say thank you for bringing the

issue of public health to this table. And I appreciate the opportunity to speak to you today, and I would just like to say that public health needs to be involved not only in biological terrorism,

which seems to be the place we are seeing more often today, but

not to forget chemical and radiological and other types of terrorism

as well.

Mr. SHAYS. Thank you.

Dr. Duchin, I want to thank you. Evidently you appeared on very

short notice when we had a cancellation, and it was thoughtful for

you to participate and your contribution.

Dr. DUCHIN. It was my pleasure to be here. Thank you.

Mr. SHAYS. Thank you very much. You’re all patient. It’s nearly

6 o’clock and this committee learned a lot. Thank you for your participation. This hearing stands adjourned.

[Whereupon, at 5:50 p.m., the subcommittee was adjourned.]

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