U.S. GOVERNMENT PRINTING OFFICE

WASHINGTON : 

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

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

Fax: (202) 512–2250 Mail: Stop SSOP, Washington, DC 20402–0001

77–377 PDF 2013

TAKING MEASURE OF COUNTERMEASURES, 

PART 3: PROTECTING THE PROTECTORS 

HEARING 

BEFORE THE

SUBCOMMITTEE ON EMERGENCY 

PREPAREDNESS, RESPONSE, 

AND COMMUNICATIONS 

OF THE

COMMITTEE ON HOMELAND SECURITY 

HOUSE OF REPRESENTATIVES 

ONE HUNDRED TWELFTH CONGRESS 

SECOND SESSION 

APRIL 17, 2012 

Serial No. 112–82 

Printed for the use of the Committee on Homeland Security 

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

COMMITTEE ON HOMELAND SECURITY 

PETER T. KING, New York, Chairman 

LAMAR SMITH, Texas 

DANIEL E. LUNGREN, California 

MIKE ROGERS, Alabama 

MICHAEL T. MCCAUL, Texas 

GUS M. BILIRAKIS, Florida 

PAUL C. BROUN, Georgia 

CANDICE S. MILLER, Michigan 

TIM WALBERG, Michigan 

CHIP CRAVAACK, Minnesota 

JOE WALSH, Illinois 

PATRICK MEEHAN, Pennsylvania 

BEN QUAYLE, Arizona 

SCOTT RIGELL, Virginia 

BILLY LONG, Missouri 

JEFF DUNCAN, South Carolina 

TOM MARINO, Pennsylvania 

BLAKE FARENTHOLD, Texas 

ROBERT L. TURNER, New York 

BENNIE G. THOMPSON, Mississippi 

LORETTA SANCHEZ, California 

SHEILA JACKSON LEE, Texas 

HENRY CUELLAR, Texas 

YVETTE D. CLARKE, New York 

LAURA RICHARDSON, California 

DANNY K. DAVIS, Illinois 

BRIAN HIGGINS, New York 

CEDRIC L. RICHMOND, Louisiana 

HANSEN CLARKE, Michigan 

WILLIAM R. KEATING, Massachusetts 

KATHLEEN C. HOCHUL, New York 

JANICE HAHN, California 

RON BARBER, Arizona 

MICHAEL J. RUSSELL, Staff Director/Chief Counsel 

KERRY ANN WATKINS, Senior Policy Director 

MICHAEL S. TWINCHEK, Chief Clerk 

I. LANIER AVANT, Minority Staff Director 

SUBCOMMITTEE ON EMERGENCY PREPAREDNESS, RESPONSE, AND 

COMMUNICATIONS 

GUS M. BILIRAKIS, Florida, Chairman 

SCOTT RIGELL, Virginia 

TOM MARINO, Pennsylvania, Vice Chair 

BLAKE FARENTHOLD, Texas 

ROBERT L. TURNER, New York 

PETER T. KING, New York (Ex Officio) 

LAURA RICHARDSON, California 

HANSEN CLARKE, Michigan 

KATHLEEN C. HOCHUL, New York 

BENNIE G. THOMPSON, Mississippi (Ex Officio) 

KERRY A. KINIRONS, Staff Director 

NATALIE NIXON, Deputy Chief Clerk 

VACANT, Minority Professional Staff Member 
(III) 

C O N T E N T S 

Page 

STATEMENTS 

The Honorable Gus M. Bilirakis, a Representative in Congress From the 

State of Florida, and Chairman, Subcommittee on Emergency Preparedness, Response, and Communications ................................................................ 1 

The Honorable Laura Richardson, a Representative in Congress From the 

State of California, and Ranking Member, Subcommittee on Emergency 

Preparedness, Response, and Communications ................................................. 4 

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

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

Security: 

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

The Honorable Robert L. Turner, a Representative in Congress From the 

State of New York: 

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

WITNESSES 

PANEL I 

Dr. James D. Polk, DO, MMM, Principal Deputy Assistant Secretary, Office 

of Health Affairs, Department of Homeland Security: 

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

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

Mr. Edward J. Gabriel, MPA, EMT/P, CEM, CBCP, Principal Deputy Assistant Secretary, Preparedness and Response, U.S. Department of Health 

and Human Services: 

Oral Statement ..................................................................................................... 11 

Prepared Statement ............................................................................................. 13 

PANEL II 

Chief Al H. Gillespie, EFO, CFO, Mifiree, North Las Vegas Fire Department, 

and President and Chairman of the Board, International Association of 

Fire Chiefs: 

Oral Statement ..................................................................................................... 24 

Prepared Statement ............................................................................................. 26 

Mr. Bruce Lockwood, Deputy Director, Emergency Management, New Hartford, Connecticut, and Second Vice President, USA Council, International 

Association of Emergency Managers: 

Oral Statement ..................................................................................................... 28 

Prepared Statement ............................................................................................. 31 

Sheriff Chris Nocco, Pasco County Sheriff’s Office: 

Oral Statement ..................................................................................................... 33 

Prepared Statement ............................................................................................. 34 

Mr. Manuel L. Peralta Jr., Director of Safety and Health, National Association of Letter Carriers: 

Oral Statement ..................................................................................................... 36 

Prepared Statement ............................................................................................. 38 
Page

IV 

FOR THE RECORD 

The Honorable Gus M. Bilirakis, a Representative in Congress From the 

State of Florida, and Chairman, Subcommittee on Emergency Preparedness, Response, and Communications: 

Statement of the National Sheriffs’ Association ................................................ 2 

APPENDIX 

Questions Submitted by Chairman Gus M. Bilirakis for James D. Polk ............ 49 

Questions Submitted by Chairman Gus M. Bilirakis for Edward J. Gabriel ..... 50 

Questions Submitted by Ranking Member Laura Richardson for Edward J. 

Gabriel .................................................................................................................. 50 
(1) 

TAKING MEASURE OF COUNTERMEASURES, 

PART 3: PROTECTING THE PROTECTORS 

Tuesday, April 17, 2012 

U.S. HOUSE OF REPRESENTATIVES, SUBCOMMITTEE ON EMERGENCY PREPAREDNESS, RESPONSE, AND COMMUNICATIONS, COMMITTEE ON HOMELAND SECURITY, Washington, DC. 

The subcommittee met, pursuant to call, at 2:03 p.m., in Room 

311, Cannon House Office Building, Hon. Gus M. Bilirakis [Chairman of the subcommittee] presiding. 

Present: Representatives Bilirakis, Turner, and Richardson. 

Mr. BILIRAKIS. The Subcommittee on Emergency Preparedness, 

Response, and Communications will come to order. 

The subcommittee is meeting today to receive testimony on efforts to ensure the protection of emergency response providers in 

the event of a chemical, biological, radiological, or nuclear attack. 

I now recognize myself for an opening statement. 

This hearing is the third in a series held by the subcommittee 

on the vital issue of medical countermeasures. The subcommittee 

has received testimony on challenges in the research, development, 

and acquisition of medical countermeasures and all plans and 

strategies to distribute and dispense diagnostics, medications, and 

other life-saving equipment. 

Today we continue this discussion with a focus on how we protect 

those who protect the public in the event of a chemical, biological, 

radiological, or nuclear attack or emergency. 

As noted by the WMD commission, the threat of WMD terrorism 

remains. The better we prepare, the more we reduce the risk. I 

know everyone agrees. Medical countermeasures are but one component that allows us to do so, and yet they are such a critical 

piece of this that they deserve special attention as far as I am concerned. It is a critical piece of the puzzle. 

As we learned at our last hearing, there are a number of dispensing methods under consideration. We have two distinguished 

panels of witnesses here today to help us further assess these plans 

and strategies at the Federal, State, and local levels and to discuss 

how best to protect emergency response providers and their families through mechanisms such as voluntary pre-event vaccination 

and the predeployment of med kits. 

The provision of such assets to targeted populations is not without precedent. The United States Postal Service has a program 

well underway in several cities to deliver medical supplies to the 

public in the event of a biological emergency. As a condition of par-
2 

ticipation, the Postal Service required that the letter carriers themselves and their families be provided with antibiotic med kits in advance in order to ensure their own protection. Kits and a program 

were then developed with the FDA backing, of course, to achieve 

this. 

Yet the law enforcement members that will escort the letter carriers from home to home do not yet have the same option. The assistant secretary for preparedness and response at HHS is working 

with the FDA to rectify this, and I look forward to hearing from 

Mr. Gabriel on the progress toward this important issue. 

Another priority that we have heard from the first responder 

community is its desire for access to anthrax vaccine. Given the 

millions of doses in the National stockpile that annually expire and 

are then discarded, it would seem entirely reasonable to make 

these supplies available to first responders prior to their expiration. 

That would benefit, of course, the responders who respond frequently to white powder incidents that may some day turn out to 

be the real thing, and it would certainly work for those of us who 

do not want to see Federal resources wasted. 

I look forward to hearing from Dr. Polk and from our second 

panel how the pilot is proceeding and what needs to happen to 

make it successful. I also think that we should look beyond the anthrax threat and have a frank discussion about what other measures, if any, should be taken with regard to other biological, chemical, and radiological threats. It is in all of our interests to ensure 

that our protectors are protected and that their families are protected and that they are able to come to work and do their jobs 

when duty calls. That will keep us all safer and more secure. 

Our previous hearings in this series have highlighted the challenges we face in developing countermeasures and getting them to 

the people who need them. First and foremost in our minds should 

be our first responders, and I look forward to discussing this with 

all of you today, how we can make this endeavor a success. 

Before I recognize our Ranking Member, I ask unanimous consent to enter a statement from the National Sheriffs’ Association 

into the record. Without objection, so ordered. 

[The information follows:] 

STATEMENT OF THE NATIONAL SHERIFFS’ ASSOCIATION

APRIL 11, 2012 

Dear Chairman Bilirakis and Ranking Member Richardson: I would like to thank 

you for allowing the National Sheriffs’ Association (NSA) to submit a statement for 

the record for the House Subcommittee on Emergency Preparedness, Response, and 

Communications Hearing on ‘‘Taking Measure of Countermeasures (Part 3): Protecting the Protectors,’’ held on April 17, 2012. 

The National Sheriffs’ Association (NSA) is one of the largest associations of law 

enforcement professionals in the United States, representing more than 3,000 elected sheriffs across the Nation, and a total membership of more than 20,000. NSA 

is a non-profit organization dedicated to raising the level of professionalism among 

sheriffs, their deputies, and others in the field of criminal justice and public safety. 

The NSA and its members are pleased that your committee continues to place a 

priority on protecting emergency services personnel. By protecting the protectors, we 

believe the Nation is and will remain more resilient in the face of natural catastrophes or intentional attacks on our communities. Further, we note that, in the 

case of a bioterrorism incident such as a wide-area anthrax attack, the responders’ 

household members will need protection as well. Research shows the inclusion of the 

protection of family members as a key component in the willingness of responders 
3 

to report for duty in biological incidents. As responders put their lives on the line 

for their community, they deserve to have peace of mind from knowing that protective antibiotics are immediately available to their household members as well as 

themselves. 

Since the May 12, 2011 hearing of your subcommittee, we can report or cite little 

progress toward the goal of an adequately protected workforce. The priorities highlighted in the testimony provided by Chief Tan on behalf of the Emergency Services 

Coalition for Medical Preparedness (NSA is a founding member) remains 

unaddressed, and is as germane today as 11 months ago. 

Emergency services personnel will be among the first exposed in an event, and 

will have the greatest need for timely access to appropriate medical countermeasures. The time is right to provide emergency services personnel caches of prepositioned personal and institutional medical countermeasures. The existing processes developed since 2004 to distribute med kits to postal workers could be extended to include the protection of our fire service, law enforcement, emergency 

medical services, public works, and other components of our emergency services sector critical infrastructure. 

We augment this statement only to make explicit that the prepositioned med kits 

in the homes and workplaces of postal workers participating in the National Postal 

Model cover their entire households. Thus, knowing that their household members 

already have protective antibiotics in hand if they should be needed, the postal 

workers are poised to deliver medical countermeasures to every residence in targeted areas in 1 day as soon as supplies arrive from the Strategic National Stockpile. 

On March 27 this year, your subcommittee convened to hear the budget request 

from the DHS Office of Health Affairs (OHA). Assistant Secretary Garza described 

the OHA’s Medical Countermeasures (MCM) Initiative. This initiative provides 

100% of DHS personnel with immediate access to life-saving antibiotic medications 

in the event of a biological attack to ensure front-line operations can perform their 

duty to save American lives. Their proposed budget request was to extend this initiative to cover an additional 350 field locations. 

On April 2, 2012 the Food and Drug Administration (FDA) held an advisory panel 

on the issue of defining a pathway for FDA approval of med kits. No first responder 

agencies were invited to testify, despite our continued interest in this issue and 

well-known policy position. In contrast, numerous public health and medical associations were invited to provide testimony, despite having no stated policy position on 

these issues. 

The emergency preparedness system in this country is essentially local, with mutual aid support from State and Federal authorities. To leave our local emergency 

services personnel and their families unprotected is to invite additional difficulties 

in responding to large-scale biological events. In light of the proposed DHS initiatives, it creates a disparity of the ‘‘haves’’ and ‘‘have-nots.’’ As you know, DHS will 

not be the first responders to communities in need. The true responders will be the 

sheriffs and their deputies in communities across the country that the National 

Sheriffs’ Association is proud to represent. We fully support what Dr. Garza advocates for DHS and desire to have those same protections given to local responders, 

including the deputies and their families. These individuals will be the first on the 

scene, the first in danger, and the first to make the decision to leave their families 

and stand in harm’s way. They must be minimally provided the same opportunity 

for protection as DHS employees. 

We support the November 2011 Institute of Medicine (IOM) report that recommends against issuing med kits to all U.S. households in favor of an approach 

of issuing med kits to specific populations, where there is sufficient education, control, and programmatic oversight. The emergency services agencies and personnel 

are that specific population; we are entrusted by our citizenry to carry guns, work 

with hazardous materials in life-threatening situations, and enter areas unsure of 

the potential for harm. We are sworn to uphold the law and if necessary give our 

lives performing that duty, but currently cannot be entrusted to have a supply of 

potentially life-saving antibiotics on hand for ourselves and our other household 

members to permit us to respond when we will be most needed. 

The NSA urges you to support the creation of a commercial med kit to be used 

by the first responder community and their households and continue to support the 

provision of a voluntary anthrax immunization program for all emergency services 

personnel. 

Thank you for your consideration of this matter. 
4 

Mr. BILIRAKIS. I now recognize the Ranking Member, Ms. Richardson from California, for any statement that she may want to 

make. 

Thank you. 

Ms. RICHARDSON. Good afternoon. 

I first want to start off by thanking our witnesses for being here 

today and for your service on behalf of this country, especially our 

first responders in our second panel. 

We thank you as well. 

I am particularly encouraged with Mr. Gabriel, with his background of being a first responder. I think the administration did a 

great job of getting good people in the right positions. So we look 

forward to working with you. 

Traditionally, when we think of first responders, we tend to 

think of public safety, police, and fire. They are always the ones 

that are there. But today we are expanding that definition and I 

think getting a sense of the other individuals who support our first 

responders on a regular basis. 

Since 2004, the United States Postal Service has worked with 

the Department of Homeland Security and the Department of 

Health and Human Services to develop a system to augment the 

point of distribution network to facilitate a rapid distribution of 

countermeasures after a biological attack. 

In 2005, the Centers for Disease Control recognized that if a 

major biological event were to overwhelm local response, invoking 

our letter carriers in the process would be critical to saving lives. 

The critical role the United States Postal Service can play in distributing medical countermeasures was recognized by President 

Obama in Executive Order 13527, which directed the Federal Government to develop a National U.S. Postal Service medical countermeasures dispensing model to respond to a large-scale biological attack. Today the resulting National postal model is in operation in 

St. Paul-Minneapolis, and we look forward to hearing about your 

success as well as the new program to be launched in Louisville, 

Kentucky. 

The program’s success can be attributed to the patriotism of postal workers and the careful planning on behalf of HHS, DHS, and 

the Postal Service and many other Federal, State, and local partners who have worked together to ensure that the postal employees 

who participated in this program and their families have access to 

prepositioned medical countermeasures. 

Now when we look at this issue in these very tough fiscal times, 

I find it ironic that we are having a discussion about including 

other folks in our first responder model, particularly our letter carriers and postal workers, when we are just over on the Senate side 

having a discussion about whether we are going to maintain 6 days 

a week service and keep postal offices open. So it seems kind of 

ironic, here we are talking about giving more responsibility and 

utilizing a resource that we know is needed, yet in the same vein, 

we are talking about cutting it and could very well eliminate our 

ability to use this program. 

Therefore, I urge in the testimony a real frank discussion about 

the potential impacts of this program and whether, if some of the 

proposed changes are brought to fruition, do we really think that 
5 

they would be met in light of some of the potential cuts that are 

being proposed? I question if, in fact, that can happen. 

Further, some of my concerns are, is that there has been a delay 

in issuing the guidance, and we look forward to getting some feedback on when that can be expected. 

Then finally, with this committee, I am hoping that we will in 

fact bring to markup H.R. 2356, which was pulled, the WMD Prevention and Preparedness Act of 2011, which would have a great 

impact on medical countermeasures for first responders. 

With that, I thank all of you, both panels, Nos. 1 and 2, for your 

willingness to testify and the information that you will share with 

us to make better decisions on behalf of the American public. 

With that, Mr. Chairman, I yield back the balance of my time. 

Mr. BILIRAKIS. Thank you. 

Other Members of the subcommittee are reminded that opening 

statements may be submitted for the record. 

[The statements of Ranking Member Thompson and Mr. Turner 

follow:] 

STATEMENT OF RANKING MEMBER BENNIE G. THOMPSON

APRIL 17, 2012 

Good afternoon. I want to thank Chairman Bilirakis for holding this hearing. 

Adequately trained and equipped first responders are the foundation of our response plans. 

We cannot afford to miss opportunities to provide first responders the tools they 

need to protect the public. 

For 26 years, I served as a volunteer firefighter. 

When we were called to action, we responded. 

When first responders across this country are called to action, they know that inaction or delay can cost lives. They have to act. 

DHS needs to adopt a first responder mindset. 

In 2008, the Homeland Security Council directed DHS to develop guidance on the 

appropriate measures for first responders to take following an anthrax attack. 

Draft guidance was released in 2009. The final guidance has yet to be issued. 

Earlier this year, the full committee was scheduled to mark up H.R. 2356, the 

‘‘WMD Prevention and Preparedness Act of 2011.’’ 

That legislation, introduced by a former Member of this committee, Congressman 

Pascrell, would have directed the Department of Health and Human Services to 

make surplus vaccines and countermeasures with a short shelf-life available to first 

responders. 

The same legislation would have reauthorized the Metropolitan Medical Response 

System, which permits local governments to use grant funding to buy countermeasures to protect first responders and their families. 

Unfortunately, the Majority cancelled mark-up of this vital legislation. 

I hope that today’s hearing can be used to gain additional information on the importance of this legislation and help this committee move toward full committee consideration of H.R. 2356. 

I look forward to hearing from the witnesses and I yield back the balance of my 

time. 

STATEMENT OF HON. ROBERT L. TURNER

APRIL 17, 2012 

Chairman Bilirakis, Ranking Member Richardson, and fellow Members. I would 

like to welcome the witnesses appearing before us this afternoon. 

To paraphrase the Roman poet Juvenal, we are gathered here today to ask ‘‘Who 

protects the protectors?’’ First responders put their lives on the line each day in the 

service of their fellow citizens. If there is another attack on the U.S. homeland, they 

will be the first on the scene and the ones most at risk. 
6 

We know that the more we prepare, the lower their risk will be. Medical countermeasures are an important element of our overall emergency preparedness—for we 

cannot ask men and women to stand in harm’s way without taking the proper precautions to ensure their safety. 

We must also recognize that first responders perform best when they know their 

families are safe. The pre-staging of medical countermeasures in the homes of first 

responders for use by all family members will ensure their peace of mind and allow 

them to turn their attention to the pressing tasks at hand. I am heartened by evidence that supplies can be safely stored in homes without risk of tampering or improper use. Studies demonstrating a 97% compliance rate evidence the dedication 

and training of these professionals. 

Voluntary anthrax immunizations from expiring stockpiles of the Strategic National Stockpile are another innovative use of Government resources. The distribution of vaccines to first responders 6 months before expiration avoids waste and 

maximizes the number of emergency workers who are pre-immunized. 

Finally, it is important to look beyond the anthrax threat to other biological, 

chemical, and nuclear dangers. It is not enough to develop countermeasures—for we 

must also ensure their proper and effective distribution. The delivery of emergency 

medicine via the U.S. Postal Service (the ‘‘Postal Model’’) does show promise. There 

are, however, questions that must be addressed before we can be entirely satisfied 

with this solution. 

I look forward to hearing from the witnesses today, and yield back the balance 

of my time. 

Mr. BILIRAKIS. I am pleased to welcome now our first panel of 

witnesses. Our first witness is Dr. J.D. Polk. Dr. Polk is the principal deputy assistant secretary for health affairs and deputy chief 

medical officer of the Department of Homeland Security, a position 

he has held since November 2011. 

Prior to joining DHS, Dr. Polk served as the deputy chief medical 

officer and chief of space medicine at NASA’s Johnson Space Center. He also served as assistant professor at the Departments of 

Preventive Medicine and Emergency Medicine at the University of 

Texas Medical Branch. Dr. Polk received his degree in osteopathic 

medicine from A.T. Still University in Clarksville, Missouri. He 

holds a masters of science in space studies with a concentration in 

human factors from the American Medical Military University and 

a masters in medical management from Southern California’s Marshall School of Business. 

Following Dr. Polk, we will receive testimony from Edward Gabriel. Mr. Gabriel is the principal deputy assistant secretary for 

preparedness and response at the Department of Health and 

Human Services. 

Prior to joining ASPR, Mr. Gabriel served as the director of global crisis management and business continuity for the Walt Disney 

Company. Mr. Gabriel previously served as a paramedic in the 

New York City Fire Department’s Emergency Medical Service and 

was assigned to the New York City Office of Emergency Management as a deputy commissioner for planning and preparedness. 

Mr. Gabriel earned his bachelor’s degree from the College of New 

Rochelle and his masters in public administration from Rutgers 

University. 

Welcome, sir. 

Your entire written statements will be entered into the record. 

I ask that you each summarize your testimony for 5 minutes. 

We will start with Dr. Polk. 

Thank you. You are recognized, Doctor. 
7 

STATEMENT OF JAMES D. POLK, DO, MMM, PRINCIPAL DEPUTY ASSISTANT SECRETARY, OFFICE OF HEALTH AFFAIRS, 

DEPARTMENT OF HOMELAND SECURITY 

Dr. POLK. Thank you Chairman Bilirakis, Ranking Member Richardson, Congressman Turner, and distinguished Members of the 

committee. It is an honor to testify before you today and alongside 

my colleague from ASPR, Mr. Ed Gabriel, on the Department of 

Homeland Security’s efforts regarding medical countermeasures for 

first responders. 

These issues are particularly important to both Mr. Gabriel and 

myself as we have started out our careers as first responders. This 

committee is very familiar with the Office of Health Affairs’ role 

and responsibilities. OHA provides health and medical expertise in 

support of the DHS mission to prepare for, respond to, and recover 

from all threats. We are the principal medical and health authority 

for DHS and the legislative coordinator for biodefense within the 

Department. 

Today I will discuss a few medical countermeasures and first responder initiatives currently under way by the Department and in 

concert with our interagency partners. The unremitting threat of 

an anthrax attack using biological agents requires that we continue 

to remain vigilant. A wide-area attack using aerosolized Bacillus 

anthracis is one of the most serious biological threats facing the 

United States. A successful anthrax attack could potentially encompass hundreds of square miles, expose hundreds of thousands of individuals, cause illness, death, fear, societal disruption, and significant economic damage. 

If untreated, the disease is nearly 100 percent fatal. Those exposed must receive life-saving medical countermeasures as soon as 

possible following their exposure. There is no indication of a specific credible anthrax attack against the United States at this time. 

However, due to the risks and consequences associated with such 

an event, it is a priority of the Federal Government and DHS to 

ensure the readiness of the Nation’s first responders and Federal, 

State, local, Tribal, and territorial governments to enhance their 

capacity to respond to a biological attack. 

The mission of DHS includes enhancing response capabilities at 

the State and local levels. Communities stand to benefit if they 

have prevaccinated responders able to deploy immediately. DHS, in 

partnership with CDC, is codeveloping a concept for a pilot project 

that would provide expiring anthrax vaccines to responders, as you 

mentioned, as they would have an increased chance of exposure reflective to their response function. Responders would decide on an 

individual basis whether or not to be vaccinated. 

Understanding that all events are local, we work directly with 

State and local public health emergency response, law enforcement, 

emergency management, and emergency medical services leaders to 

develop response capabilities for health security threats, including 

biological threats. For example, OHA together with FEMA conducted a series of anthrax response exercises at each of the 10 

FEMA regions designed to help coordinate roles, responsibilities, 

and critical response actions following a wide-area anthrax attack. 

In 2009, OHA requested comments from the public and interested stakeholders on draft guidance developed through an inter-
8 

agency process for appropriate protective measures for responders 

in the immediate post-attack environment of an aerosolized anthrax attack. Since then both DHS and HHS’ Office of the Assistant Secretary of Preparedness and Response have worked diligently together to develop consensus guidance. The guidance will 

reflect the most current understanding and evidence-based medicine for protective countermeasures after a wide-area anthrax attack. 

Finally, all of these efforts combined with our Biowatch and our 

National Biosurveillance Integration Center, or NBIC, form a contiguous biosurveillance and situational awareness system that 

serves to enhance the ability of local responders to be alerted to 

and respond quickly to biological attacks. DHS has developed and 

will continue to refine integrated multidisciplinary detection and 

biosurveillance capabilities to provide the Federal Government and 

State and local partners with the tools necessary to respond to unfolding biological events. 

In conclusion, thank you again for the opportunity to testify 

today. The Department of Homeland Security values the work of 

the Nation’s first responders and will continue to support them in 

their critical preparedness and response efforts. I look forward to 

any questions that you may have. 

[The statement of Dr. Polk follows:] 

PREPARED STATEMENT OF JAMES D. POLK

APRIL 17, 2012 

Good afternoon, Chairman Bilirakis, Ranking Member Richardson, and distinguished Members of the subcommittee. It is an honor to testify before you today on 

the Department of Homeland Security’s (DHS) efforts regarding medical countermeasures (MCM) for first responders. 

As you are aware, the Office of Health Affairs (OHA) provides health and medical 

expertise in support of the DHS mission to prepare for, respond to, and recover from 

all threats and hazards. OHA’s responsibilities include: Serving as the principal advisor to the Secretary and the Federal Emergency Management Agency (FEMA) Administrator on medical and public health issues; leading and coordinating biological 

and chemical defense activities; providing medical and scientific expertise to support 

DHS preparedness and response efforts; and leading the Department’s workforce 

health and medical oversight activities. OHA also serves as the primary DHS point 

of contact for State, local, Tribal, and territorial governments on medical and public 

health issues. 

OHA has four strategic goals that coincide with the strategic goals of the Department: 

1. Provide expert health and medical advice to DHS leadership; 

2. Build National resilience against health incidents; 

3. Enhance National and DHS medical first responder capabilities; and 

4. Protect the DHS workforce against health threats. 

Today I will discuss a number of MCM and first responder initiatives that support 

our strategic goals. 

EXECUTIVE ORDER 13527: ESTABLISHING FEDERAL CAPABILITY FOR THE TIMELY

PROVISION OF MEDICAL COUNTERMEASURES FOLLOWING A BIOLOGICAL ATTACK

Executive Order (E.O.) 13527 seeks to mitigate illness and prevent death, sustain 

critical infrastructure, and complement State, local, Tribal, and territorial government MCM distribution capacity. The threat of an attack using a biological agent 

is real and requires that we remain vigilant. A wide-area attack using aerosolized 

Bacillus anthracis, the bacteria that causes anthrax, is one of the most serious mass 

casualty biological threats facing the United States. A successful anthrax attack 

could potentially encompass hundreds of square miles, expose hundreds of thousands of people, and cause illness, death, fear, societal disruption, and significant 
9 

economic damage. If untreated, the disease is nearly 100 percent fatal; those exposed must receive life-saving MCM as soon as possible following exposure. 

In particular, Section 4 of the E.O. directs Federal agencies to establish mechanisms for the provision of MCM to personnel to ensure that the mission-essential 

functions of the Executive Branch departments and agencies continue to be performed following a biological attack. Due to the nature of the DHS mission, a significant portion of our workforce performs mission-essential functions, and others could 

be exposed during daily activities. As a result, Secretary Napolitano directed DHS 

to develop a plan and seek funding for a capacity to provide emergency antibiotics 

to all DHS employees in an attacked area, not just those who are mission-essential. 

OHA leads this effort for DHS and we are pleased to say that DHS is among the 

first Federal agencies to have met this requirement of the Executive Order. 

STOCKPILING AND FORWARD-CACHING OF MCM

In the past year, OHA successfully introduced an MCM strategy to mitigate the 

impact of a biological attack on DHS personnel. As part of this strategy, OHA implemented a plan to purchase and stockpile MCM for all DHS employees, those in DHS 

care and custody, working animals, and contractor employees with DHS badges. 

DHS identified regional cache locations for every DHS Component in order to preposition MCM across the country for employees to have immediate access after a 

biological incident. 

In order to make the plan both cost-effective and protect even our most remotelylocated employees, OHA worked with the Centers for Disease Control and Prevention (CDC) and the Food and Drug Administration (FDA) to draft an Emergency 

Use Authorization (EUA) that would permit, among other things, the stockpiling 

and distribution of 10-day courses of doxycycline at component caches and dispensing of the medication by non-health care professionals. This EUA was issued 

by the FDA Commissioner on July 21, 2011. OHA was then able to forward-cache 

nearly 200,000 courses of MCM to 127 field locations for regional stockpiling, in addition to centrally stockpiling additional MCM that might need to be utilized following an incident. OHA continues to partner with FDA to satisfy regulatory considerations for re-labeling and forward-caching of MCM. In addition, pre-EUA submissions are in place to support a possible EUA for ciprofloxacin, an antibiotic that is 

also effective for post-exposure prophylaxis of inhalational anthrax. 

Until an EUA for ciprofloxacin is issued, DHS is restricted to distributing this 

countermeasure in the currently approved 60-day courses and through a traditional 

medical dispensing model utilizing DHS health care providers, including the Department’s more than 3,500 Emergency Medical Service Technicians (EMTs). However, 

provisions in both House and Senate versions of the Pandemic and All-Hazards Preparedness Act (PAHPA) reauthorization bill would, if enacted, facilitate such preevent and response activities. 

In the event of a biological incident, it is important to remember that all affected 

DHS personnel and their families will also have access to MCM from the Strategic 

National Stockpile through existing community points of dispensing (PODs). 

ADVISING DHS LEADERSHIP ON HEALTH AND MEDICAL ISSUES

Serving as the principal advisor to the Secretary and FEMA Administrator on 

medical and public health issues has afforded OHA the ability to ensure synergistic 

efforts in implementing a Department-wide strategy for MCM. OHA provides guidance and comprehensive planning information to DHS components through the Anthrax Operations Plan Department Guidance Statement (DGS) in coordination with 

the Office of Operations Coordination and Planning, develops and delivers training 

on dispensing of the MCM, assists operational components in the development of 

dispensing plans and conducts DHS points of dispensing (POD) exercises. To supplement the DGS, OHA also provides medical guidance for MCM storage, administration, and non-medical PODs, as well as medical treatment for working and service 

animals exposed to anthrax spores. We are now in the process of sharing lessons 

learned and coordinating with the Federal interagency to ensure the consistency of 

plans across the Federal Government, including our partners at the Department of 

Health and Human Services (HHS), CDC, and the FDA. 

Coordinated medical oversight provided by OHA ensures that the Department’s 

MCM program and medical treatment rendered pursuant to the program is uniform 

and consistent to National standards. Currently, OHA has a medical liaison officer 

(MLO) responsible for the provision of medical guidance, support, and leadership at 

FEMA, which has proven to be a very successful model. We are in the process of 

establishing MLOs with Customs and Border Protection (CBP), the Transportation 

Security Administration (TSA), and Immigration and Customs Enforcement (ICE) to 
10 

support their operational workforces. These Components will benefit from coordinated and centralized medical programmatic direction and guidance from OHA, 

along with an established protocols system that will support and enhance steadystate and deployment readiness activities. The Department as a whole will be better 

situated to prepare for and respond to disasters and significant events through the 

increased depth in medical leadership this structure provides. 

RESPONSE GUIDANCE FOR FIRST RESPONDERS

OHA also provides our State, local, Tribal, and territorial partners with guidance 

for protection of personnel responding to a wide-area anthrax attack. Through the 

Federal interagency process, OHA and HHS’s Office of the Assistant Secretary for 

Preparedness and Response (ASPR) co-led the effort to develop consensus guidance 

regarding appropriate protective measures for first responders in the immediate 

post-attack environment of an aerosolized anthrax attack. The guidance reflects the 

most current understanding of the unique environment that would exist after a 

wide-area anthrax release. The guidance is a prudent step to provide to first responders the best information on protective measures currently available. 

PRE-EVENT ANTHRAX VACCINATION FOR RESPONDERS

In July 2009, the CDC Advisory Committee on Immunization Practices (ACIP) 

stated that by priming the immune system before exposure to Bacillus anthracis 

spores, pre-event vaccination might provide more protection than antimicrobial 

drugs alone to persons at risk for occupational exposure. ACIP recommendations 

state that, ‘‘Emergency and other responders are not recommended to receive routine pre-event anthrax vaccination because of the lack of a calculable risk assessment. However, responder units engaged in response activities that might lead to 

exposure to aerosolized B. anthracis spores may offer their workers voluntary preevent vaccination. The vaccination program should be carried out under the direction of a comprehensive occupational health and safety program and decisions for 

pre-event vaccination should be made based on a calculated risk assessment.’’ (Centers for Disease Control and Prevention, 2010) 

‘‘Responders’’ refers to a diverse set of individuals who perform critical services 

necessary to mitigate the potential impact of a wide-area anthrax attack. These responders may either be in the area identified as the point of initial release and/or 

are called in from elsewhere to provide follow-on activities in a contaminated area 

performing critical services. Our National response capability to a wide-area anthrax attack would be enhanced by having pre-vaccinated responders, able to deploy 

immediately and confident that they have been afforded as much protective status 

as possible for these activities. Pre-event vaccination of these responders will increase the ability to save lives, maintain social order, and ensure continuity of Government after a wide-area anthrax attack. 

The CDC’s Strategic National Stockpile (SNS) approached OHA in June 2011 with 

the idea of working collaboratively to determine a use for anthrax vaccine with a 

short shelf life rather than disposing of the unused vaccine. Anthrax vaccine is currently stockpiled in the CDC’s SNS to support State and local response during a 

widespread aerosolized anthrax release. Based on DHS threat assessments and the 

Department’s prioritization of efforts for anthrax preparedness, voluntary pre-event 

vaccination of responders is deemed to be an appropriate step to prepare for this 

threat. 

Therefore DHS and CDC SNS are developing a program for the provision of expiring anthrax vaccine to Federal departments and agencies, as well as State and local 

jurisdictions for the voluntary pre-event vaccination of responders. Each Federal, 

State, local, Tribal, or territorial program must meet eligibility requirements, including the existence of a comprehensive occupational health and safety program 

through which to manage a vaccination program for anthrax vaccine. It is important 

to note that the Federal Government is not establishing a Federal vaccination program for State and local responders, but rather providing an existing resource to 

States and localities who will implement the vaccination program within their jurisdictions. No funding or other resources for any administrative programmatic support requirements will be associated or available through DHS or HHS outside of 

the provision of the physical vaccine. Such a program would distribute anthrax vaccine to responders at greatest risk of exposure and would not impact vaccines needed for Department of Defense (DOD) personnel recommended to receive the vaccine 

for general use prophylaxis. 

As part of the program development process, CDC and OHA formed a Federal 

interagency working group to discuss key decision points regarding voluntary preevent anthrax vaccination of responders. This working group convened a series of 
11 

meetings to discuss scientific medical data and policy implications among subject 

matter expert representatives from over twelve different Federal departments. The 

group developed pre-event anthrax vaccine risk prioritization guidance for use in the 

event that demand exceeded supply of vaccine. This guidance identifies the categories of responders eligible to receive pre-event anthrax vaccine, contingent on 

supply and current threat assessment. All categories of responders identified in this 

guidance are considered at sufficient risk of future exposure to anthrax to warrant 

voluntary pre-event vaccination, should the supply be sufficient at the time of the 

request. 

The first step to initiate this pre-event anthrax vaccine distribution program is 

to pilot the program on a small and manageable scale to ensure the methodology 

supports responsible vaccine use and to help the U.S. Government understand demand for the vaccine. The pilot program will provide data to allow us to make 

changes to improve program management and to help scale up the program, as 

needed, to achieve a safe, reliable, functional, and sustainable capability to widely 

distribute vaccine, within the constraints of existing program capacity. The pilot will 

include two Federal departments or agencies and two State or local jurisdictions (including Tribal and territorial jurisdictions) interested in working with DHS OHA 

and CDC SNS to deliver this program to a pilot cohort of responders. Those selected 

will manage a voluntary anthrax vaccination program for a minimum of 18 months, 

in order to accommodate the full 5-dose priming series of vaccine to the volunteer 

recipients. 

CONCLUSION

Thank you again for the opportunity to testify today. The Department of Homeland Security values the work of the Nation’s first responders and we are always 

looking for ways to support them in their critical preparedness and response efforts. 

I look forward to any questions that you may have. 

Mr. BILIRAKIS. Thank you, Dr. Polk. 

Mr. Gabriel, you are recognized for 5 minutes. 

STATEMENT OF EDWARD J. GABRIEL, MPA, EMT/P, CEM, CBCP, 

PRINCIPAL DEPUTY ASSISTANT SECRETARY, PREPAREDNESS AND RESPONSE, U.S. DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Mr. GABRIEL. Good afternoon Chairman Bilirakis and Ranking 

Member Richardson and Members of the subcommittee. 

I am Edward Gabriel, the principal deputy assistant secretary for 

preparedness and response at the United States Department of 

Health and Human Services. Thank you for inviting me here today 

on behalf of HHS to testify on protecting first responders. 

Before I describe HHS efforts to protect first responders, I want 

to note that before joining ASPR 7 months ago, I spent 30 years 

as an emergency medical technician, paramedic, and chief with the 

New York City fire department emergency medical services. I was 

on ground prior to the collapse of the towers on September 11 as 

a deputy commissioner of emergency management and personally 

witnessed the heroism and sacrifices of fellow first responders. 

I understand the needs of first responders, and I truly believe 

that we in the Federal Government are making a difference in our 

Nation’s preparedness and will continue to improve the lives of 

those who are doing work on the ground every single day. 

As good stewards of our limited Federal resources, HHS and our 

Federal partners are developing tools and strategies with all-hazards adaptability for our first responders. One tool in development 

is the med kit. The anthrax med kits would contain antibiotic 

doxycycline along with instructions for appropriate use in home. 

Med kits would be available in advance of an emergency to particular groups, such as first responders and families. While further 
12 

research is needed to ensure med kits can be safely stored and 

used in private homes, HHS is optimistic about this capability and 

its implications for our first responders’ protection during a public 

health or medical emergency. 

The second tool in the development is the postal model. HHS 

awarded the National postal model grants in specific cities and jurisdictions throughout the country. These grants fund planning and 

exercises to incorporate U.S. Postal Service’s employee volunteers 

into community plans to deliver countermeasures after an anthrax 

bioterrorism attack. 

Recently, HHS supported a tabletop exercise in Louisville, Kentucky. Our primary focus of this exercise was to determine the 

roles of law enforcement and postal workers in the delivery of medical countermeasures under real-life circumstances. HHS is planning another full-scale exercise in Minneapolis on May 5 to examine issues and implications for the delivery of countermeasures to 

approximately 40,000 households in four zip codes. Since this program began in 2010, we have captured lessons learned from various exercises and have improved future applications and planning 

guidance. 

As we analyze these results, we will coordinate with our partners 

and incorporate best practices into similar applications. We are 

also developing a new and improved medical countermeasures and 

personal protective equipment to protect first responders in their 

communities. Since Project BioShield was authorized in 2004, HHS 

has built a robust pipeline of next-generation medical countermeasure products. We have funded over 80 candidate products 

that, if successful, will have the potential to transition to procurement contracts and inclusion in the Strategic National Stockpile. 

I would like to note that funding for Project BioShield expires in 

2013. You and your colleagues are working to reauthorize the Pandemic All-Hazards Preparedness Act, which includes the reauthorization of appropriations for Project BioShield through 2018. The 

reauthorization of PAHPA supports our work and will ensure we 

continue to have tools necessary to respond. 

Lastly, as my colleague from DHS mentioned, I would like to 

note that we are in the final phases of completing guidance for first 

responders following an anthrax attack. This is a significant step 

in protecting first responders, and I look forward to sharing more 

on this guidance in the near future. 

In conclusion, all of our efforts come down to the same goals: 

Building a resilient Nation and saving lives when emergencies 

occur. This is true for all of us, whether at the Federal, State, local, 

or private sector. 

Before I came to ASPR, I was a director of global crisis management and business continuity for the Walt Disney company. My 

work required strong development of protective relationships 

worldwide with law enforcement, emergency management, intelligence services, as well as my private-sector counterparts. Based 

on my experiences, I have learned that meeting the needs of first 

responders before, during, and after an event is critical. I look forwarded to working with you to ensure that our progress continues 

and we, as a Nation, are truly prepared. 
13 

I thank you for the opportunity to testify before you today, and 

I would be happy to answer any questions you may have. 

[The statement of Mr. Gabriel follows:] 

PREPARED STATEMENT OF EDWARD J. GABRIEL

APRIL 17, 2012 

Good afternoon Chairman Bilirakis, Ranking Member Richardson, and Members 

of the subcommittee. I am Mr. Edward Gabriel, the principal deputy assistant secretary for preparedness and response (ASPR) at the U.S. Department of Health and 

Human Services (HHS). Thank you for inviting me here today, on behalf of HHS, 

to testify on protecting first responders. 

Before I begin this afternoon, I want to mention that maintaining and supporting 

our State and local response capability is of particular personal significance to me. 

Before joining ASPR 6 months ago, I spent 30 years as a first responder. I began 

as an emergency medical technician (EMT) then became a paramedic working 

throughout the city of New York. I rose through the ranks to become a New York 

City Fire Department Emergency Medical Services system assistant chief and ultimately became the deputy commissioner for planning and preparedness in New 

York City’s Office of Emergency Management. I was on the ground with other first 

responders prior to the collapse of the towers on September 11, 2001 and personally 

witnessed the heroism and sacrifices of our first responders. I have spent my career 

responding to emergencies. I understand the needs of first responders and I truly 

believe that what we in the Federal Government are doing is making a difference 

in our Nation’s preparedness and will continue to improve the lives of those doing 

the work on the ground. 

This afternoon I’m going to talk to you about the unique role that HHS plays in 

protecting and supporting the Nation’s first responder community and helping them 

become more resilient after tragedy strikes. Our strategic approach involves creating best practices for getting medical countermeasures to first responders quickly 

in a range of emergency situations; developing promising new products, tools, and 

technologies to protect our first responders and giving them the tools needed to be 

successful; and integrating behavioral health into overall public health and medical 

preparedness, response, and recovery planning. First responders are defined as a diverse set of individuals (emergency medical services practitioners, firefighters, law 

enforcement, and HAZMAT personnel, the emergency management community, public health and medical professionals, skilled support personnel, emergency service 

and critical infrastructure personnel, certain other Government and private sector 

employees, and individual volunteers assisting in response activities) who are critical to mitigating the potential catastrophic effects of public health emergencies. I’ll 

talk about our new approaches to coordination where Federal, State, local, Tribal, 

territorial, and private-sector partners comprise the ‘‘medical countermeasures enterprise’’ and come together to collaborate and plan the development and deployment of countermeasures. Our approach throughout this enterprise takes the whole 

system into account—from early research to deployment—and includes the needs of 

first responders. I’ll also focus on the first responder community not only in the context of medical, fire, and police but also other critical human services and how you 

and I, our families, and those in our communities might also play critical roles in 

a first response. I hope to leave you today with a clear picture of our work in this 

area and our proactive strategies to continue progress. Our Nation’s ability to respond to an emergency depends on truly collective approaches and a strong partnership with our State and local partners who have the primary role in those first critical moments when the speed and thoughtfulness of response translates into more 

lives saved. 

Supporting and assisting our Nation’s first responders is a top Federal priority; 

however, we all recognize that the act of first response occurs primarily at the State 

and local level. Therefore, we focus attention on empowering States and communities to prepare for and respond to emergencies as safely, effectively, and efficiently 

as possible. As we are all aware, when disasters strike it is the response from the 

local community during the minutes before and after the event that saves lives. Our 

communities need to be resilient and be able to respond quickly. Today, State and 

local communities are more resilient than ever before. Incidents including the tornadoes that touched down in Alabama and Missouri in 2011 and recent flooding in 

Louisiana demonstrated how State and local communities are able to respond during the initial stages of the public health emergency response with little to no need 

for Federal assistance. HHS’ Hospital Preparedness Program (HPP) and Public 
14 

Health Emergency Preparedness (PHEP) cooperative agreement programs support 

State and local resilience by funding preparedness activities and infrastructure at 

State and local public health and medical facilities. A Hospital Preparedness Program report entitled ‘‘From Hospitals to Healthcare Coalitions: Transforming Health 

Preparedness and Response in Our Communities,’’ describes the achievements of 

our State partners in building health care preparedness across the Nation, and illustrates how States have used the capabilities developed and funded through the 

program in both large and small incidents. One specific accomplishment detailed in 

this report is that more than 76 percent of hospitals participating in the HPP met 

90 percent or more of all program measures for all-hazards preparedness in 2009. 

These activities promote community resilience and improve health outcomes following emergencies and disasters. 

Despite HPP and PHEP investments, the financial realities we are all facing 

today continue to challenge our public health and medical infrastructure and, ultimately, communities’ ability to be resilient. We are already witnessing a decline in 

the State and local public health workforce as a result of these fiscal constraints. 

As good stewards of Federal resources, we must focus on developing tools and 

strategies for all-hazards which can be implemented in a range of emergencies. If 

a chemical, biological, radiological, nuclear (CBRN), or emerging infectious disease 

incident were to occur, we might have a few minutes or hours, not days, to dispense 

medical countermeasures to treat first responders and their communities, depending 

on the nature, scope, and size of the event. We will need first responders on the 

ground as soon as possible to treat the health impacts of the event and maintain 

the safety and security of their communities. In the aftermath of an event we will 

rely on multiple modalities to protect first responders, including pre- and post-event 

treatments. This treatment strategy is central to many of our preparedness plans 

including those for anthrax, smallpox, influenza, and other agents. For bacterial 

threats, antibiotics offer one of the best courses of action as vaccines can take days, 

weeks, or months to be effective unless provided to responders before-hand. For example, the CDC’s Advisory Committee on Immunization Practices recommends a 

three-dose anthrax vaccination regimen, as a post-exposure prophylaxis, for responders following an event, in addition to antibiotics. While the first vaccine dose 

would be administered as soon as possible post-exposure, the second and third doses 

would be administered 2 and 4 weeks later. The vaccine is not immediately effective 

and is not fully protective until after that third dose. Antibiotics are an important 

part of treatment strategies to bridge time gaps by maximizing protection from vaccines post-exposure. 

To provide a quick and effective response, first responders will need to receive the 

most effective treatments quickly. I am pleased to say that Federal partners are 

working better together to ensure that we have the best tools available to treat and 

respond effectively to public health and medical emergencies. Federal partners are 

collaborating via the Public Health Emergency Medical Countermeasures Enterprise 

(PHEMCE)—the overarching interagency convening body for medical countermeasure development, stockpile, and use. ASPR leads the PHEMCE, which brings 

together three primary HHS agencies—the National Institutes of Health (NIH), the 

Centers for Disease Control and Prevention (CDC), and the Food and Drug Administration (FDA)—along with four key interagency partners—Department of Homeland 

Security (DHS), Department of Defense (DoD), Department of Veterans Affairs (VA), 

and Department of Agriculture (USDA). Working together full-time, as an enterprise, we are coordinating, exchanging information, and learning from each other 

daily to optimize preparedness and response for public health emergencies. The 

PHEMCE is bringing together partners not only to identify and support the development of a number of novel medical countermeasures to protect first responders but 

to also identify and plan for the use and distribution of acquired products. 

Today, HHS and other Federal partners are working to develop new tools with 

potential all-hazards adaptability to support and protect first responders. While 

HHS does not lead first responder activities, we do have a critical and unique role 

in advancing promising approaches in response at the National level which can then 

translate into local use. One such approach in the development and pre-approval 

phases is the anthrax ‘‘med kit.’’ The anthrax med kits contain the antibiotic 

doxycycline along with instructions for appropriate use in the home. Upon approval, 

med kits would be available in advance of an emergency to particular groups such 

as first responders and their families. These med kits could be purchased directly, 

either by the first responders themselves or their employers. While further research 

is needed to ensure med kits can be safely stored in private homes without misuse, 

we are optimistic about this capability and its implications for first responder protection during a public health or medical emergency. 
15 

As you know, we have already seen success in the use of the med kit concept 

through pilot testing the National U.S. Postal Service (USPS) medical countermeasures dispensing program. Supporting implementation of actions described in 

Executive Order 13527, Medical Countermeasures Following a Biological Attack, HHS has invested $10 million since 2010 to support National Postal Model grants 

awarded to specific cities and jurisdictions throughout the country. The grants fund 

planning and exercises to incorporate USPS employee volunteers into community 

plans to deliver medical countermeasures after an anthrax bioterrorism attack. 

Under this model, volunteer USPS letter carriers receive pre-event antibiotics via 

a Home Antibiotic kit that they store in their homes; these are for themselves and 

household members. If a public health or medical emergency requiring medical 

countermeasures occurred, letter carriers and their household members would be instructed to begin taking their antibiotics. This would allow these USPS volunteers 

to perform their mission, as outlined in the National Postal Model, to deliver antibiotics as prescribed by their specific postal plans. Law enforcement officers accompany the letter carries as they deliver the antibiotics to homes in predetermined ZIP 

codes. Since this program began, we have learned lessons from the various exercises 

and have improved future applications and planning guidance. Recently, HHS held 

a table-top exercise in Louisville, KY. A primary focus was determining the roles 

of law enforcement and postal workers in delivery of medical countermeasures 

under ‘‘real-life’’ circumstances. HHS is planning another full-scale exercise in Minneapolis on May 5 to examine issues and implications for the delivery of countermeasures to approximately 40,000 households in four zip codes. As we analyze results, we will coordinate with our partners and incorporate best practices into similar applications. 

As we work with our partner agencies to develop all-hazards tools to support first 

responders, we must also develop policy documents to guide efforts to protect first 

responders and their communities from an anthrax attack and other emergencies. 

These interagency guidance documents will provide clarity and improve coordination 

to ensure that the needs of all responders are met before, during, and after an emergency. It is critical that strategies are developed before an event to ensure that the 

tools available for all responders are used to their maximum capacity. 

In addition to developing the policies themselves, there will be implementation 

challenges, including monitoring recipients of pre-event vaccinations, and in the 

aftermath of an event, the immediate availability of adequate vaccine and the availability of resources to support vaccination in the midst of an on-going event will 

need to be addressed. These challenges span the regulatory authorities and resources of several Federal agencies and departments, as well as those of our State 

and local partners. HHS is actively engaging with interagency partners to address 

these challenges and establish policies for the distribution of medical countermeasures to first responders, not just for anthrax, but for all potential hazards and 

threats. As such, the resulting guidance documents will be considered ‘‘living documents’’ in the sense that they will be refined as the evidence base is strengthened 

for determining exposure risk and the efficacy of protective measures and feedback 

is received from stakeholders. Even as we update existing guidance and disseminate 

new guidance, we will look forward to continuing dialogue with our stakeholders 

and partners in the first responder community. 

We’ve done considerable work in developing novel approaches to get medical countermeasures to first responders quickly and coordinate at all levels of government 

to ensure that our first line of defense is protected in an emergency. However, we 

are also looking forward and developing new and better medical countermeasures 

to both protect first responders and the communities they live in, as well as improving their tool kit to treat those affected. In August 2010, HHS Secretary Sebelius 

released the Public Health Emergency Medical Countermeasures Enterprise Review: 

Transforming the Enterprise to Meet Long-Range National Needs (MCM Review). 

The MCM Review examined the steps involved and made recommendations regarding the research, development, and regulatory approval of medications, vaccines, 

and medical equipment and supplies for a public health emergency. In implementing recommendations of the MCM Review, HHS has already made progress in 

improving the entire medical countermeasure pipeline—from early stage research 

and development to distribution. 

As I mentioned earlier in my testimony, the PHEMCE is bringing together partners to identify and to support the development and deployment of a number of 

novel medical countermeasures to protect first responders. My office works closely 

with HHS partners including NIH, CDC, and FDA to develop, procure, and stockpile 

medical countermeasures for CBRN threats as well as emerging infectious diseases, 

including pandemic influenza. We are now more prepared for a broad range of 

threats and emerging infectious diseases than at any point in our Nation’s history. 
16 

We have a robust pipeline of next-generation products—we have gone from having 

very few products in the medical countermeasure pipeline over the last decade to 

funding over 80 candidate products that, if successful, have the potential to transition to procurement contracts and inclusion in the SNS. These products include: An 

entirely new class of antibiotics; anthrax vaccine and antitoxins; a new smallpox 

vaccine and antivirals; radiological and nuclear countermeasures including candidates to treat the various phases of acute radiation syndrome; pandemic influenza 

countermeasures; and chemical antidotes. In many cases, these products represent 

the future for enhanced protection of first responders. 

Since Project BioShield—the primary tool HHS uses to procure novel CBRN medical countermeasures for the SNS—was authorized in 2004, HHS has strengthened 

internal and external contracting mechanisms, and research and development pathways, and has incorporated lessons learned from past challenges. As my colleague 

at DHS will detail, there is much discussion about the pre-event vaccination of first 

responders against threats such as anthrax. However, the current vaccine regimen 

is burdensome as it requires five vaccinations over 18 months and annual boosters 

to produce immunity. We all agree that all responders have to be adequately protected, and if a decision is made to make anthrax vaccine available to them, it would 

help to have vaccines that require fewer immunizations. As part of its efforts to develop vaccines to protect the entire civilian population, HHS is currently investing 

in more than 20 programs for next generation anthrax vaccines, four of which have 

transitioned from early to advanced research and development. The programs have 

the potential to provide protective immunity with 3 doses of vaccine or less, are 

easier to administer, and have a decreased life-cycle cost due to lack of the cold 

chain requirement. 

Funding for Project BioShield expires in 2013 and work to reauthorize the Pandemic and All-Hazards Preparedness Act (PAHPA) is on-going. The proposed legislation includes the reauthorization of appropriations for Project BioShield through 

2018. Investing in development of medical countermeasures, novel approaches to response operations, and our public health infrastructure is critical in ensuring that 

adequate medical countermeasures are available for dispensing as soon as possible 

following the start of a public health incident. The reauthorization of PAHPA will 

support our work and will ensure we continue to have the tools necessary to respond. 

As part of our strategic approach to encouraging innovation in medical countermeasure development, we are also developing new tools for all responders and a 

number of these efforts are already showing results. HHS is developing a next generation portable ventilator that will be lighter and less expensive, making it easier 

and quicker to administer critical treatments. In 2007, HHS convened a blue ribbon 

panel of experts to review the state of ventilators in the market against the requirements for use in all-hazards preparedness. In September 2010, an advanced research and development contract was awarded to Newport Medical in California for 

design and development of a next-generation portable ventilator that is at a highlyaffordable price point and that could be used with minimal training on a broad 

range of patients from neonates to adults. A prototype was developed by July 2011 

and is currently being evaluated. The initial results are promising and the program 

is on schedule to file for market approval in September 2013. 

As we develop medical countermeasures to respond to public health and medical 

emergencies we must not ignore the needs of first responders and their communities 

after an event. Community-based responders are the first to arrive on the scene 

when an incident occurs and they remain in the community through recovery. A 

major event such as an aerosolized anthrax attack will require response and recovery activities long after the initial threat has passed. First responders will play a 

key role in these locally-led recovery efforts toward the restoration of public health 

and medical services. First responders are the backbone of our public health and 

safety infrastructure; by supporting them, we ensure that the human infrastructure 

remains intact throughout the response and recovery phases, and ready for the next 

emergency. Recovery is a part of preparedness, and the National Disaster Recovery 

Framework, released in September 2011, provides guidance to all levels of government, the private and nonprofit sectors, and individuals and families on activities 

they can undertake both pre- and post-disaster to plan for a successful recovery. 

HHS leads the Health and Social Services Recovery Support Function under that 

framework, and ASPR has established a Recovery Coordination Office to carry out 

those responsibilities and also leverage opportunities to incorporate recovery into 

on-going preparedness efforts. We have also supported innovation and continuous 

improvement in our efforts to support first responders and others during the recovery phase. Based on lessons learned in Hurricanes Katrina and Rita, HHS recognized the need for enhanced coordination of disaster-related health care, mental 
17 

health and human services needs at all phases of response. Today HHS’ Administration for Children and Families, in partnership with FEMA, administers the Federal 

Disaster Case Management Program, which provides disaster survivors with a single point of contact for accessing resources and services to address disaster-caused 

needs, and for developing and completing a personalized Disaster Recovery Plan. 

While they are not first responders in the traditional sense, our disaster case managers are on the ground in the aftermath of a disaster providing support to their 

fellow responders and impacted individuals. 

In addition to supporting officially designated and trained first responders, we are 

also leveraging the internet to supplement the first response. In particular, under 

the America Competes Act, we are issuing a ‘‘challenge’’ for development of a webbased application able to automatically deliver a list of the top-five trending illnesses from a specified geographic region in a 24-hour period. Under the envisioned 

program, data would then be sent directly to State and local health practitioners 

to use in a variety of ways, including building a baseline of trend data, engaging 

the public on trending health topics, serving as an indicator of potential health 

issues emerging in the population, and cross-referencing other data sources. The 

more we know and the earlier we understand emerging health trends, the better 

prepared we all are—including first responders—in providing treatment to affected 

individuals and limiting the impact of the event. 

In conclusion, all of our investments and efforts come down to the same goals— 

building a resilient Nation and saving lives when emergencies occur. This is true 

for all of us, whether in the Federal, State, local, Tribal, territorial, or private sector. Before coming to ASPR, I was the director of global crisis management and 

business continuity for the Walt Disney Company. In this position I was responsible 

for the development and implementation of global policy, planning, and training to 

manage crises for The Walt Disney Company. I was also responsible for East and 

West Coast Medical and Emergency Medical Operations as well as the Walt Disney 

Studio’s Fire Department. My work with Disney required development of strong and 

productive relationships with law enforcement, emergency management and intelligence services counterparts, as well as private sector counterparts world-wide. 

Based on my experiences, meeting the needs of our first responders before, during, 

and after an event is critical. We have made great strides toward building a robust 

enterprise to develop medical countermeasures and to quickly get them to people 

who need them. We are incorporating the clinical community into National preparedness systems and are preparing clinicians to treat patients affected by emergencies. We are collaborating with State and local partners to develop, exercise, and 

improve their response capabilities. All of our efforts will ensure the next public 

health or medical emergency is responded to in the best, most effective way possible. 

I look forward to working with you to ensure that this progress and our strategies 

for the future continue to prepare the Nation and save lives. 

Thank you for the opportunity to testify before you today. I am happy to answer 

any questions you may have at this time. 

Mr. BILIRAKIS. Thank you for your testimony. I appreciate it very 

much. 

I will recognize myself for 5 minutes for questions. 

This question is for Dr. Polk and Mr. Gabriel. On October 2009, 

DHS published draft guidance for protecting the health of first responders immediately following a wide-area anthrax attack. We 

know that the first responder community is waiting for this guidance, and of course, our Ranking Member brought this up in her 

opening statement. Of course, the guidance has since become a 

joint effort between DHS and HHS. So my question, of course, is 

for both of you. Please tell me where this guidance is and why is 

it now more than 30 months since a draft was received and we still 

don’t have the final guidance published that our first responders 

can use to prepare for any type of an event? If you can both address that, I would appreciate it. Thank you. 

Dr. POLK. Sure. Thank you, Mr. Chairman. 

First off, I am happy to report both Ed and I have worked diligently with our counterparts in DHS and HHS on this guidance to 

get it moving forward, and it was approved by the DRG earlier this 
18 

month. My last understanding is that it is going through the signature cycle, getting all of the interagency logos applied to it, and 

then it will very soon—within the coming weeks—go through the 

final interagency vetting process and then be released. 

So I think it was Dr. Garza in his testimony that said we were 

rounding third and heading for home, and I think we are almost 

home. 

Mr. BILIRAKIS. Okay. So give me a better estimate. Be more precise as to when you think our first responders will get the guidance. 

Dr. POLK. I think that will depend on if we get any comments 

back from the interagency vetting process. If we have any other 

comments back from any of the interagency’s partners, it may take 

a little bit longer to vet those. But I would imagine we would have 

that, quite frankly, by mid-May. 

Mr. BILIRAKIS. Why has it taken so long? 

Dr. POLK. I think initially, you know—and to be as precise as I 

can, a lot of it is to make sure that we had the absolute best level 

of evidence to go into the document. Because there were changes 

in evolution over the last several years as to what is the best PPE 

equipment to use, what is the best treatment for anthrax, and also, 

as we had all of these other different programs come on-line, 

whether it was vaccination, whether it was pre-event vaccination 

or post-event vaccination, we wanted to make sure that this document was contiguous with other programs that were coming out, 

that we did not cause confusion or actually add to a problem with 

our first responders by having one document that said one thing 

and a second document that said another that was a follow-on document for public health. So we wanted to make sure that we vested 

a lot of time to get this right the first time. 

It is still going to be released as a draft so we can get public comment when the folks see it because we are under no guise that we 

have anticipated all the issues that may confront the first responders. But we wanted to make sure that we had it right because 

these folks, quite frankly, are going to be rushing into an anthrax 

event in a hot zone, and this is not something where we wanted 

to leave a lot of guesswork. 

Mr. BILIRAKIS. Okay. Thank you. 

Mr. Gabriel. 

Mr. GABRIEL. Well, I have seen the overall document since getting to ASPR back in November and September, and I have taken 

a look at it. I know our offices have been working closely within 

our partners at the HHS side, the Centers for Disease Control, as 

well as all of our other partners to make sure that the guidance 

was clear enough to meet the needs of somebody who is on the 

ground. 

The issue with anything like this is it can’t be perfect. When you 

try to look at guidance like this, you want to keep it as general for 

the people that are really in the field to understand and use appropriately. Sometimes when you look at document development like 

this, you get a lot of technical sort of concepts put into something 

that needs to be operationalized at the field level. I have seen that 

from my experiences over the last. 
19 

So we took a good hard shot over the last few months fixing 

those gaps and making sure that it meets the needs of responders 

more clearly so that when they look at and give us their input 

again on this, they are able to say, hey, this will work in the field. 

I think that is important. So I think that we are just a handful of 

days away from getting this out. Again, I can’t speak for the process above me. But I think the first responder community will be 

generally happy with it, when it gets their visibility on it. 

Mr. BILIRAKIS. Thank you. 

Dr. Polk, you discussed in your testimony that your office is 

working on guidelines for the use of expiring doses of anthrax vaccine in the National Stockpile for provisions on a voluntary basis. 

You mentioned, of course, to first responders. We know that such 

a program is of course a priority. It also sounds like good Government. We are going to save money. It is a better alternative to 

throwing away millions of perfectly good vaccines. I am sure you 

will agree. In fact, legislation under consideration by this committee has asked for that very thing. 

I would like to hear more about the pilot and to understand your 

principles for implementation, even though the program guidance 

is not yet ready. I would also like to hear how this program will 

differ from the unsuccessful smallpox vaccination effort for health 

care workers undertaken by the Federal Government a few years 

before. So if you could respond, I would appreciate it. 

Dr. POLK. Yeah. Thank you, Mr. Chairman and thanks for the 

opportunity to talk about this novel program. 

Obviously, DHS has worked hand-in-glove with our HHS CDC 

partners on this. As you mentioned, the Strategic National Stockpile has vaccine that expires every year, sometimes to the tune of 

about 2 million doses, $48 million per year, that we have to recycle, 

throw out when it expires and recycle. The goal of this pilot program is to take this vaccine approximately 6 months before it expires and make it available to the State and local governments as 

a prevaccination or pre-event vaccination program for their folks. 

Again, I have to stress it is a pilot, meaning that the goals of a 

pilot are to discover where are the gaps, where are the lessons 

learned before we distribute this more widely or make this a more 

wide program. I believe we have worked diligently with CDC on 

the nuances of how to get the logistics of the vaccine from the 

stockpile to the State and locals. I believe what they are looking 

at right now is the legal departments from each are looking at, 

where do we have the authorization to spend appropriated funds, 

under what section, whether it is through FEMA or whether it is 

through CDC, et cetera, to get the vaccine there, essentially pay for 

postage, to make sure that we can get the vaccine there to the 

State and locals? 

Mr. BILIRAKIS. Which States are you proposing to participate in 

the pilot project? 

Dr. POLK. Well, I believe the States are going to, you know, have 

an application process to apply and to essentially allow the States 

to volunteer. The criteria are going to be fairly short and succinct. 

They need to have an occupational surveillance program so that 

they can monitor any vaccine reactions, et cetera. They need to 

have a good distribution program. They need to make this vol-
20 

untary. Those are the basic guidelines that the States are going to 

have to use. But we obviously want to make sure that if they are 

going to give this vaccine that they have good follow-up for anyone 

who has a vaccine reaction, that they can answer questions, that 

they can educate the folks who are going to get the vaccine properly. So those are the criteria that the States would use initially. 

So they are not going to be very rigid. So hopefully we will get a 

fair amount of folks that are willing to engage in the program. 

Mr. BILIRAKIS. Thank you. 

I recognize you for 5 minutes, Ranking Member Richardson. 

Ms. RICHARDSON. You mean 8 minutes and 18 seconds. 

Dr. Polk, can you tell me how much has been spent on the anthrax vaccine and what is the expected shelf life? 

Dr. POLK. Well, I can’t tell you offhand. The Strategic National 

Stockpile is owned by CDC. So I would have to defer to my colleagues in HHS exactly as to what the cost is that they spend on 

that vaccine or what the expected shelf life is. But typically, FDA 

has medications for a 1-year shelf life for the most part. Although 

certain medications can be extended based on the type of medication or what buffer are in those medications to extend their shelf 

life. But I would have to defer to my colleagues. 

Ms. RICHARDSON. Mr. Gabriel, do you know the answer to that? 

Mr. GABRIEL. Well, if the answer is on this card, I do. I have just 

been told that we spent $2 billion. It has got a 4-year shelf life. 

Ms. RICHARDSON. Mr. Polk, did I understand you correctly that 

hopefully the guidance would be out by mid-May in draft form? 

Dr. POLK. I would hope so. That is assuming that with all of the 

vetting that we have done on this document, which we have done 

a great deal, that I imagine that we have resolved a lot of the 

interagency questions that have come about before. So, hopefully, 

it will slide fairly quickly through that vetting process. 

Ms. RICHARDSON. In the second panel, we are going to be able 

to ask the question of the letter carriers, what they feel the impact 

might be if, in fact, they are experiencing cutbacks as has been proposed, which I certainly do not support. But have you had an opportunity to think about—either of you gentlemen—if the Postal 

Service is not able to serve in support of this program, what your 

other options would be? 

Mr. GABRIEL. Well, I will start first, and then J.D. will take it 

from there. 

From a postal model perspective, I was actually out in Louisville 

talking to the postal workers directly on this. They want to volunteer and participate. But they are a piece of an overall process that 

involves management, that has come out of our all-hazards preparedness programs and our BioShield programs, including points 

of dispensing, both closed and open points of dispensing models. 

The postal model itself, we are looking at med kits. 

So if you look at an overall approach, if the postal model system 

begins to show and continues to show that it is effective, clearly, 

as we move forward, that has to be in our arsenal for protecting 

first responders and civilians. 

Ms. RICHARDSON. No, my question was if it is not available to 

you. 
21 

Mr. GABRIEL. We will have to use different models as we already 

are. 

Ms. RICHARDSON. Is there anything else sufficient to the 

level—— 

Mr. GABRIEL. Yeah. I think our points of dispensing models are 

good. I think the CDC, working with our DHS partners, have tested those models across large municipalities where real good work 

has been done for a number of years. 

Ms. RICHARDSON. Is there any—and I apologize for cutting you 

off. But we were called for votes here. I was teasing the Chairman 

about extending my time. 

Mr. BILIRAKIS. We are going to try to go another round, too, if 

we possibly can. 

Ms. RICHARDSON. My question is: Is there any other means—I realize the CDC has its process. But I don’t know of any other means 

that could do the actual residence-to-residence distribution and 

have that kind of process in place. Is there anything else that compares to that? 

Mr. GABRIEL. Resident-to-resident model, hand-delivered, no, it 

doesn’t exist now. However, the med kit, home med kit process certainly has some implications relative to that. But we are not there 

yet. 

J.D., want to answer? 

Dr. POLK. Yes. At least from a DHS perspective, I don’t think 

there is a one-size-fits-all that is going to work in any particular 

community. I think whether it is pods, home med kits, postal 

model, what may work in a rural area may not work in an inner 

city. I think as many models that we can use to help augment or 

distribute, to shorten the time for medication to exposure certainly 

is going to be supported by DHS. 

Ms. RICHARDSON. Okay. Do either of you have any idea of when 

the public health emergency medical countermeasures enterprise 

plan will be released? That is in reference to October of last year. 

GAO reported that between 2007 and 2010, HHS invested $4.3 billion into countermeasures development, both the acquisition and 

research and development. HHS and DHS updated risk assessments and inventoried the Strategic National Stockpile that HHS 

has not updated the countermeasure investment priorities set forth 

in the Public Health Emergency Medical Countermeasures Enterprise Plan of 2007. HHS has confirmed to GAO that it would release an updated priorities plan in the spring of this year. 

Mr. GABRIEL. Let me take that one, councilman—excuse me— 

Congresswoman. It is that New Yorker in me testifying in front of 

the New York City Council versus the Congress. 

So two things about that. Just a little bit about the overall approach we are doing with this, and then I will give you a specific 

answer. We have tried to build this plan by making sure that 

whatever we put in this overall program has an end-to-end approach, so that it is useful on the side for responders and it has 

the scientific input. To give you the quick answer to that, we are 

expecting release of that by this summer. 

Ms. RICHARDSON. Thank you. 

I yield back. 
22 

Mr. BILIRAKIS. Thank you. We are going to try to go another 

round. I am going to go ahead and ask one more question, and I 

am going to give the Ranking Member an opportunity as well. 

Then we are going to have to break for votes. We have three votes 

pending, and then we will come right back. We will dismiss the 

first panel now, after we finish our questions, and then we will 

start with the second panel as soon as we finish for votes. Okay. 

Mr. Gabriel, your agency met with FDA just a couple of weeks 

ago to get the FDA’s initial thoughts on an approval process for a 

first responder antibiotic med kit. There appears to still be some 

concerns in the public health and regulatory community over misuse of antibiotics. In your opinion, do you think the first responders, as well-educated members of the medical and law enforcement 

communities would be likely to handle the medication appropriately? Can you site any scientific studies that demonstrate that 

this might not be the case? What does your data from the current 

postal plan suggest? 

Mr. GABRIEL. Well, thank you for that question. There was a 

meeting at the FDA, and there was a discussion about this. I think 

both the first responder community as well as the scientific and 

medical community talked to this advisory panel to the FDA. There 

are two sides to this particular discussion. But from a perspective—we are excited on our side and are looking at the med kits 

as a potential option here from the HHS ASPR side. The FDA has 

looked at it and will come to us, get back to us with more formal 

regulations or recommendations from them directly. So to answer 

on what the outcome is going to be, I don’t know. 

However, as a first responder, we are dedicated people. We are 

trusted to do a lot of different things in a lot of different environments. Most of the studies and materials I have seen on this show 

that in the past studies that we have run these kinds of things, the 

people are dependable to handle these things appropriately. 

However, in the end, the overall recommendation comes through 

the FDA, and that is what we are going to wait for. But first responders every day are going into your houses, taking care of people with heart conditions, cutting you out of buildings and doing 

the things that they put their lives on the line to do every day. 

They are dependable people. 

Mr. BILIRAKIS. I definitely agree with you. 

Okay, I will recognize the Ranking Member for at least one question. 

Ms. RICHARDSON. You mentioned—well, we talked a little bit 

about well it has taken almost 3 years now to get the guidance. So 

as we get ready to look at appropriations, you may want to advise 

the folks that you work with that it really puts this project in great 

vulnerability if we haven’t received the guidance if we want further 

funding. Since it is coming up to expire for 2013, what would be 

the case that either of you would make of why we absolutely need 

to continue the program? I am referring to the BioShield. 

Mr. GABRIEL. BioShield funds a number of different programs 

that we really do need the money for. The whole point of the dispensing process came through that. We use that funding every single day for a number of different projects in treating and preparing 

emergency response people to be ready during disaster. BioShield 
23 

is a terrific program. Overall, there will be gaps in our ability to 

move forward on product development that are already in the pipeline if the funding doesn’t come through. I mean, there is a lot 

more detail there. But the answer to the question as straightforward as I can, we want to make sure it is a continuum of the 

good work that is done so far on the projects and developments of 

countermeasures with over 80 of them in the pipeline. 

In addition to that, we also have used it for the development and 

acquisition of incentives to industry to make sure that the industry 

has a clear path forward and is willing to commit to us as a Government to continue to work on these projects. 

Ms. RICHARDSON. Okay. If you could supply to the committee, if 

the Chairman does not object, the details of why you think it is so 

critical to continue and what are the benefits. Then if you could 

also clarify how much of the funds are actually being spent on expiring products, such as anthrax, oxidants, and a smallpox vaccine. 

Mr. BILIRAKIS. I do not object. So ordered. 

Okay. Well, thank you very much. I want to thank you for your 

service. Thank you for your testimony today. Without objection, 

what we will do is we will dismiss the first panel, and then we are 

going to recess, and we will be returning following votes. Thank 

you very much for your patience. 

[Recess.] 

Mr. BILIRAKIS. Well thank you very much for your patience. I 

really appreciate it. 

I want to welcome our second panel. Our first witness is Chief 

Al Gillespie. Chief Gillespie is the president and chairman of the 

board of the International Association of Fire Chiefs and serves as 

the fire chief of the City of North Las Vegas, Nevada. Chief Gillespie holds a bachelors of science in fire administration and has 

completed a fellowship at Harvard’s Kennedy School of Government. 

Next, we will receive testimony from Mr. Bruce Lockwood. Mr. 

Lockwood serves as deputy director of emergency management for 

the town of New Hartford, Connecticut. Mr. Lockwood is also second vice president of the U.S. Council of the International Association of Emergency Managers and previously served as president of 

the IAEM Region 1. Mr. Lockwood served on the National Commission on Children in Disasters, where he chaired the Subcommittee 

on Evacuation, Transportation, and Housing, and served as a member of the Subcommittee on Pediatric Medical Care. 

Following Mr. Lockwood, we will receive testimony from Sheriff 

Chris Nocco. Sheriff Nocco is the sheriff of Pasco County, Florida, 

which happens to be in my Congressional district, a position he has 

held since May 2011. Prior to his appointment by Governor Scott, 

Sheriff Nocco served as a major and supervisor of the Pasco County 

Sheriff’s Office Joint Operations Bureau. Sheriff Nocco has also 

served as a chief of staff of the Florida highway patrol and as the 

deputy chief of staff to the then-speaker of the Florida House and 

now U.S. Senator Marco Rubio. 

Sheriff Nocco has also served as a member of the Philadelphia 

public school police, the Broward County Sheriff’s Office and the 

Fairfax County, Virginia Police Department. During his service in 
24 

Fairfax, Sheriff Nocco responded to the September 11 attacks and 

the anthrax attacks. 

Sheriff Nocco received his bachelor’s degree in criminal justice 

and his masters of public administration from the University of 

Delaware. 

Finally, we will receive testimony from Mr. Manuel Peralta. Mr. 

Peralta is the director of safety and health for the National Association of Letter Carriers, a position to which he was elected in 

July 2010. Prior to pursuing this position, Mr. Peralta held a number of positions within the National Association of Letter Carriers. 

Welcome. 

We welcome all of you. We look forward to your testimony. Your 

entire written statements will appear in the record. I ask you to 

summarize your testimony for 5 minutes, and I will first recognize 

Chief Gillespie. 

Thank you very much and you are recognized, sir. 

STATEMENT OF CHIEF AL H. GILLESPIE, EFO, CFO, MIFIREE, 

NORTH LAS VEGAS FIRE DEPARTMENT, AND PRESIDENT 

AND CHAIRMAN OF THE BOARD, INTERNATIONAL ASSOCIATION OF FIRE CHIEFS 

Chief GILLESPIE. Good afternoon, Chairman Bilirakis, Ranking 

Member Richardson, and Members of the committee. I am Al Gillespie of the North Las Vegas fire department and president and 

chairman of the Board of the International Association of Fire 

Chiefs. The IAFC is a member of the Emergency Services Coalition 

For Medical Preparedness. 

Thank you for the opportunity to represent fire and EMS responders today. 

My testimony is based upon my experiences as fire chief in several places, including North Las Vegas. As one of our Nation’s most 

attractive destinations, we are a high target for a terrorism attack. 

My department has a Homeland Security and Special Operations 

Division. On 9/11 and the days that followed, first responders 

served our Nation with little concern for their personal health. We 

have learned many lessons from the terrorist attacks that day and 

from the anthrax attacks later that year. 

With Congress’ leadership, we have raised preparedness and 

training in many areas, but there is more work to do. As chief, I 

know my personnel will respond. If you ask me if they would respond to a fire or a medical emergency, a pandemic or a biological 

attack, my answer is yes. 

However, numerous studies on the abilities and willingness of 

emergency services personnel to respond to pandemics have uncovered some concerns. The Journal of Occupation and Environmental 

Medicine published a study where only 49 percent of the participants answered that they would be both able and willing to respond to a biological incident. Another study published by the Disaster Management and Response revealed that only 38 percent of 

responders stated they would respond if their immediate families 

were not protected. However, 91 percent reported they would stay 

on duty if their families and themselves were fully protected and 

vaccinated. 
25 

Mr. Chairman, the fire and emergency services will do all we can 

to protect our communities. We need Congress to do all it can to 

protect our first responders and address a major gap in preparedness for a pandemic or biological bioterrorist attack. We should not 

wait for an attack to validate the surveys and provide absolute 

proof. 

Congress should add language during the conference committee 

for the Pandemic and All Hazards Preparedness Reauthorization 

Act that focuses on protecting first responders. Otherwise, a major 

gap in our National preparedness system will remain. The IAFC 

believes Congress should authorize the Department of Homeland 

Security and the Department of Health and Human Services to establish and test a voluntary anthrax immunization program for 

emergency first providers. In addition, Congress should direct these 

Federal departments to deploy prepositioned antibiotic kits into the 

homes of emergency service providers to protect first responders 

and their families. Extending these protections to first responders 

and their families will improve preparedness and prevent the responders from infecting their families. 

I would like to reiterate that any anthrax immunization program 

should be voluntary. The Strategic National Stockpile prepositioned 

regionally includes an anthrax vaccine for deployment after attack. 

However, if there is an attack, immediate emergency response will 

be provided by local personnel who are not necessarily immunized. 

The current plan calls for the delivery of countermeasures to States 

within 12 hours of an emergency declaration. 

The Federal policy should be changed to set up a pilot program 

that rotates nonexpired potent and safe vaccines from the SNS to 

voluntary emergency responders’ immunization programs. This 

would improve preparedness and better utilize Federal resources 

and tax dollars. Additionally, this effort could provide real-world 

practice for distributing countermeasures after an attack. As DHS 

and HHS design the program, they can create record-keeping 

guidelines that ensure that first responders who volunteer for the 

program receive the proper and full vaccinations. We have learned 

that DHS and HHS are developing pilot programs, as you have 

heard, to make vaccines in the SNS available as Federal excess 

property and are interested in receiving more information about 

this program. 

In addition, the prepositioned home med-kit program should be 

extended to emergency responders for their families. The brave 

postal workers who volunteer to distribute the antibiotics under 

the National postal model are provided prepositioned home med 

kits covering the individuals and their families. The CDC conducted a pilot study on the household’s ability to maintain the kit. 

The study found that of 4,000 households, 97 percent returned 

their med kits intact. I firmly believe the emergency response community can be trusted to follow instructions and maintain med kits 

in their homes. Prepositioned med kits into the homes of emergency personnel will address unacceptable response time gaps and 

family concerns. DHS and HHS should develop storage and use instructions for the kits. 

In conclusion, the fire and emergency response is primarily a 

local responsibility. Our ability to fulfill our mission requires prop-
26 

er preparation. Congress must address this current weakness and 

enhance emergency response providers’ willingness and ability to 

safely respond and save lives during a biological emergency. On behalf of America’s fire and emergency service leaders, thank you for 

holding this hearing and the opportunity to address the subcommittee. I look forward to answering your questions. 

[The statement of Chief Gillespie follows:] 

PREPARED STATEMENT OF CHIEF AL H. GILLESPIE

APRIL 17, 2012 

Good afternoon, Chairman Bilirakis, Ranking Member Richardson, and Members 

of the committee. I am Chief Al Gillespie, of the North Las Vegas Fire Department 

located in North Las Vegas, Nevada and the president and chairman of the board 

of the International Association of Fire Chiefs. The International Association of Fire 

Chiefs represents the leadership of over 1.2 million firefighters and emergency responders. IAFC members are the world’s leading experts in firefighting, emergency 

medical services, terrorism response, hazardous materials spills, natural disasters, 

search and rescue, and public safety policy. As far back as 1873, the IAFC has provided a forum for its members to exchange ideas, develop professionally, and uncover the latest services available to first responders. The IAFC is also a member 

of the Emergency Services Coalition for Medical Preparedness. I thank the committee for your continued interest in our Nation’s medical countermeasures and for 

the opportunity to represent fire and EMS responders during today’s hearing. 

My testimony is based upon my experiences as a fire chief. As one of our Nation’s 

most attractive tourist destinations, we in the Las Vegas area are a high target for 

a potential terrorist attack. In response, our department has stood up a Homeland 

Security & Special Operations Division composed of emergency management, tactical medics, urban search and rescue (USAR), technical rescue, and haz-mat rescue 

teams. 

Our entire department is staffed by over 200 uniformed and civilian employees 

who provide a great service to our community. Day in and day out, I count on each 

one of these proud and well-trained men and women to fulfill our diverse missions. 

As their chief, I know that they will respond rapidly and professionally when called 

upon for natural and man-made disasters. 

Throughout the fire and emergency services as we remembered the 10th anniversary of 9/11, we marked the sacrifice our men and women made that day for our 

Nation. In the days that followed, the first responders continued to serve our Nation 

with little concern for their personal health. We have learned many lessons from 

the terrorist attacks that day and from the anthrax attacks later that year. With 

Congress’ leadership and support, we have raised preparedness and training in 

many areas, but there is more work that can be done. 

As I’ve said, as a chief, I know my personnel will respond. If you asked me if they 

would respond to a fire, the answer is ‘‘yes.’’ If you asked me if they would respond 

to a medical emergency, the answer is ‘‘yes.’’ If you asked me if they would respond 

to a pandemic or a bio-attack, my answer is ‘‘yes.’’ 

However, in recent years, numerous published studies have uncovered interesting 

questions and concerns held by responders. For instance, the Journal of Occupational & Environmental Medicine published a study by Columbia University examining the factors associated with the ability and willingness of essential workers to 

report to duty during a pandemic. The study surveyed 1,103 workers from six essential workgroups in Nassau County, New York and found that although a substantial 

proportion of participants reported that they would be able (80%); much less would 

be willing (65%) to report for duty. In fact, only 49% of the participants answered 

that they would be both able and willing. 

Other studies report similar trends. A study published in a 2007 issue of Disaster 

Management & Response surveyed paramedics to examine their concerns about responding to a pandemic. In this study, 80% of respondents reported they would not 

stay on duty without protective equipment or proper vaccination. If provided protective equipment, but not a vaccine, this rate decreased to 61% of respondents reported they would not stay on duty. This study also revealed that 91% of the respondents reported they would remain on duty if they were fully protected. While 

that response rate is a good sign, it dramatically falls to a projected response rate 

of only 38% if the respondent fears that their immediate family is not protected. 
27 

Mr. Chairman, the fire and emergency services will do everything we can to protect our communities, but we need Congress to do all it can to protect first responders and address a major gap in preparedness for a pandemic or a bioterrorist attack 

in the United States. Currently, we only have surveys that suggest a lack of response, but we should not wait for an attack to provide absolute proof. Your committee has a strong legislative record of addressing gaps in preparedness from supporting legislation to allocate the D-Block to public safety to authorizing grants and 

other programs for local governments to increase preparedness capabilities. Although the Pandemic and All-Hazards Preparedness Reauthorization Act has passed 

both the House and the Senate, I am concerned that unless Congress adds language 

during the conference committee that focuses on protecting first responders, a major 

gap will continue to exist. 

As such, the IAFC believes Congress should task the Department of Homeland 

Security (DHS) and the Department of Health and Human Services (HHS) to test 

and create a voluntary anthrax immunization program. In addition, Congress 

should request these Federal agencies deploy pre-positioned antibiotic kits into the 

homes of emergency services providers to protect first responders and their families. 

The DHS and the HHS should work together to boost the immunization levels of 

all emergency services providers on a voluntary basis and protect responders and 

their families. Extending these protections to first responders and their families 

(those who live in the responder’s home) will improve preparedness and prevent the 

responder from infecting their families during times of great National need. 

VOLUNTARY ANTHRAX IMMUNIZATION PROGRAM

First, I would like to reiterate that any anthrax immunization program should be 

voluntary. We have heard great debate that an anthrax attack is a low-risk threat, 

due in part to the existence of a vaccine. This vaccine is a major tool in the Strategic 

National Stockpile (SNS), maintained by the Centers for Disease Control and Prevention (CDC), U.S. Department of Defense (DoD) and other Federal agencies, including HHS and DHS. The SNS’s cache of antibiotics, chemical antidotes, 

antitoxins, life-supporting medications, IV administration, airway maintenance supplies, and medical or surgical items is pre-positioned regionally throughout the 

country and ready to be deployed after an attack. However, if there is an attack, 

immediate emergency response will be expected by the public. Under current models, this response will be provided by local jurisdictions whose personnel are not necessarily immunized. This will result in a major lag in response, putting public safety 

and public health at great risk. The current plan calls for vaccines and medicines 

to be delivered to any State in the United States within 12 hours of Federal and 

State/local declarations. Each State then utilizes their plan to receive and distribute 

vaccines and other medicines, which will result in a lengthier time lapse before local 

emergency services and first response are deployed. 

Over time, drugs and vaccines in the SNS expire. While a Shelf-Life Extension 

Program (SLEP) has been developed for select Federal stockpiles, other vaccines and 

drugs are appropriately rotated out of the SNS and destroyed. Changing Federal 

policy to set up a pilot program that rotates non-expired, potent, and safe vaccines 

and drugs from the SNS to voluntary emergency responder immunization programs 

would greatly improve preparedness levels and better utilize Federal resources and 

tax dollars. Additionally, such an effort to rotate and release vaccines to State and 

local jurisdictions could provide real-world practice for the Federal plan to rapidly 

push out the SNS cache after an attack. 

The DHS and the HHS should work together to develop and test a voluntary anthrax vaccination pilot program, which ultimately could address a gap in preparedness and improve emergency response time to a bio-attack. As these departments 

design the program, they can create record-keeping guidelines to assist chiefs ensure their personnel who volunteer for the program receive the proper and full vaccinations. In addition, utilizing the SNS could lower the costs of standing up such 

an operation while increasing preparedness levels around the Nation. 

We have learned that DHS and HHS are developing pilot programs to make vaccines in the SNS available as ‘‘Federal excess property,’’ and are interested in receiving more information about this type of program. 

PRE-POSITIONED ANTIBIOTIC KITS IN THE HOMES OF EMERGENCY RESPONDERS

Not all bioterrorist attacks can be treated with a vaccine, which the SNS cache 

and other Federal programs take into account. The National Postal Model (NPM) 

utilizes postal workers who volunteer to dispense antibiotics after a bioterrorist attack to reduce surge at dispensing points. The brave postal workers who volunteer 

to serve their Nation in such a capacity are provided Household Antibiotic Kits 
28 

(HAKs) or med kits. These kits are pre-positioned in their homes and provide coverage for the individual and their family. This type of program should be extended 

to pre-position med kits into the homes of the emergency responders and further 

mirror the postal model to include the emergency responder’s family. 

The United States Postal Service (USPS) along with HHS, local, and State public 

health and law enforcement partners tested the operational capability to distribute 

medical countermeasures through the National Postal Model with three Cities Readiness Initiative (CRI) proof-of-concept drills (in Seattle, Boston, and Philadelphia) 

and a comprehensive pilot in Minneapolis/St. Paul. The CDC also conducted a Home 

Med-Kit Evaluation Pilot Study in St. Louis to examine the household’s ability to 

maintain the kit as directed and preserved for emergency use. This study found that 

of 4,000 households, including first responders, corporation employees, and community health clinic staff, 97% of participants returned their med kit intact at the end 

of the study. While this is just one study, I firmly believe that the emergency services community can be trusted to follow instructions and maintain med kits in their 

home. To do so, instructions for the kits will have to be developed that address best 

practices for storage, as we know that the bathroom medicine cabinet is one of the 

worst places to store medications due to temperature and humidity issues. 

Pre-positioning med kits into the homes of emergency responders will address a 

time gap in preparedness. During an attack, if first responders are waiting for the 

release of medical countermeasures from the SNS to the State and then through 

public health agencies to responders, they have indicated through multiple studies 

less inclination to report for duty. For a response to disasters or attacks, this lag 

time may create an unacceptable situation, and pre-positioned med kits for emergency responders and their families are warranted. 

Emergency response is primarily a local responsibility. First responders throughout our Nation are rightfully assumed to be able and willing to respond to emergencies including disasters and attacks. However, we do not send firefighters to a 

call without the proper equipment and training. Our ability to fulfill our missions 

requires proper preparation. Congress must address the current gaps to enhance 

emergency service providers’ willingness and ability to safely respond and save lives 

during a biological emergency. 

On behalf of America’s fire and EMS leaders, I would like to thank you for holding this hearing and the opportunity to address this subcommittee. I look forward 

to answering any questions that you may have. 

Mr. BILIRAKIS. Thank you, chief, for your valuable testimony. 

Now I will recognize Mr. Lockwood for 5 minutes. 

You are recognized, sir. 

STATEMENT OF BRUCE LOCKWOOD, DEPUTY DIRECTOR, 

EMERGENCY MANAGEMENT, NEW HARTFORD, CONNECTICUT, AND SECOND VICE PRESIDENT, USA COUNCIL, 

INTERNATIONAL ASSOCIATION OF EMERGENCY MANAGERS 

Mr. LOCKWOOD. Thank you. Chairman Bilirakis, Ranking Member Richardson, and Members of the subcommittee, thank you for 

giving me the opportunity to discuss the issue of protections afforded by medical countermeasures and their distribution from the 

perspective of the emergency services sector. I am Bruce Lockwood, 

deputy director of emergency management for the town of New 

Hartford, Connecticut, representing the Emergency Services Coalition on medical preparedness. I am the second vice president, 

IAEM USA, International Association of Emergency Managers, 

which has more than 5,000 members worldwide and is a nonprofit 

educational organization dedicated to promoting the principles of 

emergency management and representing those professionals 

whose goals are saving lives, protecting property and the environment during emergencies and disasters. 

On behalf of the coalition, I thank you for the time devoted to 

this topic. These are important hearings in developing and promoting policies that prepare the Nation and ensure our resilience. 

As James Glassman recently noted, bioterrorism remains a current 
29 

concern and that, compared with other defense expenditures, this 

one on a cost-benefits calculation, looks awfully cheap. Budgets are 

constrained. But to cut back on the only truly effective method of 

fighting bioterrorism may be worse than foolish; it could be lethal. 

Since Lawrence E. Tan, chief of emergency medical services, New 

Castle County, Delaware, representing the coalition provided testimony in front of this subcommittee on May 2011, there has been 

insufficient progress at protecting the protectors at the local level. 

This lack of progress means citizens cannot be guaranteed the continuity of provision of emergency services in all areas of the country during a large-scale biological event. I believe there are some 

simple, immediate, and commercially sound methods to start providing protections that would substantially increase our resilience. 

I urge you to express your support for a voluntary anthrax immunization program for emergency services and first responders. 

To complement this immunization program, I urge you to support the immediate development of med kits for all emergency services personnel and their households. I believe these are primary, 

necessary first steps in ensuring the continuity of emergency services during large-scale anthrax events. These steps will mitigate 

the additional demands on emergency services during the event 

and ensure responders can stay on the job without fear their families are unprotected. During bioterrorism incidents, protective antibiotics should be available immediately to the household members 

of the responders as well as for the responders themselves. The 

critical task established by DHS is that communities develop processes to ensure that first responders, public health response, critical infrastructure personnel, and their families receive prophylaxis 

prior to the opening of a community pod. 

The simplest and most effective manner to achieve this critical 

task is by combining immunization with prepositioning med kits in 

the homes and workplaces of emergency servicers. The coalition 

supports the Institute of Medicine’s 2011 report that rejects the 

idea of distributing antibiotics to the general community in favor 

of targeted population-specific distribution. Emergency services are 

that specific population with specific needs and specific circumstances. There is strong consistent evidence that we cannot assume emergency services providers are confident in their ability to 

serve in large-scale events, notably biological events. In no professional category can emergency providers be guaranteed to report 

for duty; in cases where they might infect their family members, 

less than half would report. 

I want to draw your attention to an area of acute concern, the 

protection of children. From 2008 to 2011, I served on the Congressionally-chartered National Commission on Children in Disasters. 

The commission report states: Congress, HHS, DHS, and FEMA 

should ensure availability of and access to pediatric medical countermeasures at the Federal, State, and local level. To ensure this 

happens, stockpiles must specifically be developed for children. 

Further, the children emergency services need specific measures to 

ensure their safety while their protectors are deployed in defense 

of the community. The DHS Office of Health Affairs has provided 

the coalition a background briefing on a pilot anthrax immunization program. 
30 

I support the intent of the program, to protect emergency services personnel. This use of expiring vaccine could have the material 

benefit of the preparedness of the Nation. We must emphasize the 

protection of the protectors is paramount, not the expediency of 

this stockpile management. The vaccine was acquired many years 

ago. Lack of policy on its use is thankfully now being addressed. 

The Office of Health Affairs in its budget hearing before this committee on March 27 requested an expansion of their countermeasures program for all DHS employees. I believe this program 

has been formed by careful analysis that DHS employees are subject to disproportionate threat and require special protection. 

These same employees and their families work alongside and are 

dependent upon local emergency services personnel. The same protection should be afforded to all emergency services personnel. 

Having one leg of the three-legged response system protected is no 

protection at all. The Federal Government and others have gathered the evidence to show that the antibiotic med kits can safely 

be administered and antibiotic resistance is not a scientific concern. 

For more than 4 years, med kits have been provided on a voluntary 

basis to the U.S. Post Office employees and their families. More 

than 97 percent of these kits were returned for renewal unopened. 

Emergency services personnel routinely handle equipment and materials that are more lethal and have more profound consequences 

than the antibiotics that would be included in these med kits. Some 

responders carry guns; other administer medications to critically ill 

patients outside of a hospital, and yet others work with hazardous 

materials and life-threatening situations. 

Entrusted with these powers and responsibilities, there is no 

basis for assuming med kits would be widely abused in the homes 

of emergency services. The coalition supports the development and 

the distribution of FDA-approved antibiotic countermeasures to 

protect from anthrax all emergency services personnel and their 

families. 

Private companies are interested in developing these med kits, 

potentially bringing efficiency to the distribution administration of 

a program that could cover all Federal workers. 

The prospect of having a protected Federal workforce operating 

alongside an unprotected local emergency services personnel is 

something we should endeavor to avoid. Perceptions that there are 

different classes of responders would undermine preparedness. The 

current methods of medical countermeasures have not proven capable of meeting our National goals, including the protection of emergency services sector. New supplementary approaches are required 

to ensure those on the front line of the response community and 

their families are protected. Pre-event voluntary immunization and 

the development with commercial partners of med kits are part of 

the next generation stockpile effort. The prospect of critical infrastructure failure is real and would be compounded by a lack of National strategy to protect first responders. The protection of protectors and their families has been overlooked and must be addressed. 

I look forward to answering your questions. 

[The statement of Mr. Lockwood follows:] 
31 

PREPARED STATEMENT OF BRUCE LOCKWOOD

APRIL 17, 2012 

Chairman Bilirakis, Ranking Member Richardson, and Members of the subcommittee, thank you for giving me this opportunity to discuss the issue of the protections afforded by medical countermeasures and their distribution from the perspective of the emergency services sector. I am Bruce Lockwood, Deputy Director, 

Emergency Management, Town of New Hartford, CT, here representing the Emergency Services Coalition on Medical Preparedness. I am the 2nd Vice President of 

the U.S. Council of the International Association of Emergency Managers (IAEM), 

which has more than 5,000 members world-wide. It is a non-profit educational organization dedicated to promoting the ‘‘Principles of Emergency Management’’ and 

representing those professionals whose goals are saving lives and protecting property and the environment during emergencies and disasters. 

On behalf of the Coalition I thank you for the time devoted to this topic because 

these are important hearings in developing and promoting policies that prepare the 

Nation and ensure our resilience. As James Glassman recently noted, bioterrorism 

remains a current concern, and that ‘‘compared with other defense expenditures, 

this one—on a cost-benefit calculation—looks awfully cheap... budgets are constrained, but to cut back on the only truly effective method of fighting bioterror may 

be worse than foolish. It could be lethal.’’ 

Since last May when Lawrence E. Tan (Chief of Emergency Medical Services, New 

Castle County, Delaware) representing the Coalition provided testimony in front of 

this subcommittee there has been insufficient progress in protecting the protectors 

at the local level. This lack of progress means citizens cannot be guaranteed continuity of emergency services in all areas of the country during a large-scale biological event. I believe there are some simple, immediate, and commercially-sound 

methods to start providing protections that would substantially increase our resilience. 

I urge you to express your support for a voluntary anthrax immunization program 

for emergency services and first responders. To complement this immunization program I urge your support of the immediate development of a med kit for all emergency services personnel and their households. Public Health research has shown 

that the availability of medical countermeasures for responders and their families 

may increase their willingness to report for duty. I believe these are primary, necessary first steps in ensuring the continuity of emergency services during a largescale anthrax event. 

These steps will mitigate additional demands on emergency services during an 

event, and ensure responders can stay on-the-job without fear their families are unprotected. During bioterrorism incidents, protective antibiotics should be available 

immediately for the household members of responders as well as for responders 

themselves. The critical task established by DHS is that communities ‘‘develop processes to ensure that first responders, public health response, critical infrastructure 

personnel, and their families receive prophylaxis prior to POD opening.’’ The simplest and most effective manner to achieve this critical task is by combining immunization with pre-positioning med kits in the homes and workplaces of emergency 

services. 

The Coalition supports the Institute of Medicine 2011 report that rejects the idea 

of distributing antibiotics to the general community in favor of targeted, populationspecific distribution. Emergency services are that specific population, with specific 

needs and specific circumstances. 

There is strong and consistent evidence that we cannot assume emergency services providers are confident in their ability to serve in a number of large-scale 

events, most notably a biological event. In no professional category can emergency 

providers be guaranteed to report for duty; in cases where they might infect family 

members less than half might report. 

I want to draw your attention to an area of acute concern: The protection of children. From 2008 until 2011 I served on the Congressionally-chartered National 

Commission on Children and Disasters. The Commission report states: ‘‘Congress, 

HHS, and DHS/FEMA should ensure availability of and access to pediatric medical 

countermeasures (MCM) at the Federal, State, and local levels for chemical, biological, radiological, nuclear, and explosive threats.’’ To ensure this happens stockpiles 

must specifically be developed for children. Further, the children of emergency services providers need specific measures to ensure their safety while their protectors 

are deployed in defense of the community. 

The DHS Office of Health Affairs has provided the Coalition a background briefing on a pilot anthrax immunization program. I support the intent of the program 
32 

to protect emergency services personnel. This use of expiring vaccine could have the 

material benefit for the preparedness of the Nation, but we must emphasize that 

the protection of the protectors is paramount, not the expediency of stockpile management. The vaccine was acquired many years ago; a lack of policy on its use is 

thankfully now being addressed. 

I hope that the voluntary anthrax immunization program goals and outcomes will 

be developed with local emergency services personnel, and that the true cost of administering the program is part of future administration budget requests. Additionally, I hope this new policy direction of support for pre-event vaccination spurs HHS 

and the vaccine development community to further research and development efforts that will produce a simpler ‘‘next generation’’ vaccine that does not require five 

doses for full protection. 

The Office of Health Affairs in its budget hearing before this committee on March 

27 requested an expansion of their countermeasure program for all DHS employees. 

I believe this program is informed by the careful analysis that DHS employees are 

subject to disproportionate threats and require special protections. As our Nation’s 

emergency response system is primarily local, the key component of our system is 

left unprotected by a DHS-only focus. The same protections should be afforded all 

emergency services personnel, State, local, and Tribal. Having one leg (the Federal) 

of the three-legged stool (Federal, State, and local) response system protected, is no 

protection at all. 

The Federal Government and other private programs have gathered the evidence 

to show these antibiotic med kits can be safely administered, and that antibiotic resistance is not a scientific concern. For more than 4 years antibiotic med kits have 

been provided to volunteers in the U.S. Post Office employees and their families. 

More than 97% of these kits were returned for renewal unopened. Emergency services personnel routinely handle equipment and materials that are more lethal and 

have more profound consequences than the antibiotics that would be included in the 

med kits. Some responders carry guns; others administer medications to critically 

ill patients outside of the hospital, yet others work with hazardous materials in lifethreatening situations on a daily basis. Entrusted with these powers and responsibilities, there is no basis for assuming med kits will be widely abused in the homes 

of emergency services personnel. 

In a country where it is estimated that there are more than 50 million inappropriate antibiotic prescriptions issued for viral infections the prospect of resistance 

is a public health concern. Pre-positioning med kits with first responders is a microscopic component of overall antibiotic use, representing less than one-hundredth of 

1 percent. Trained personnel in command structures with clinical oversight can be 

trusted, as has been demonstrated daily as well as in times of great stress. 

The Coalition supports the development and distribution of FDA-approved antibiotic countermeasures to protect from anthrax to all emergency services personnel 

and their families, as a critical protective measure against anthrax and other 

agents. Private companies are interested in developing these med kits; potentially 

bringing efficiency to the distribution and administration of a program that could 

cover Federal workers (DHS, USPS) and the entire National emergency services sector. The prospect of having a protected Federal workforce operating alongside unprotected local emergency services personnel is something we must avoid, because perceptions that there are different classes of responder could undermine overall preparedness. 

The current methods of distributing medical countermeasures have not proven capable of meeting our National goals, including the protection of the emergency services sector. New supplementary approaches are required to ensure that those on the 

front lines of the response community and their families are protected. 

Pre-event voluntary immunization and the development with commercial developers of a med kit are part of a next generation protection and National stockpile 

effort. The specter of critical infrastructure failure is real, and would be compounded 

by a lack of a National strategy to protect first responders. The protection of the 

protectors and their families has been overlooked, and must be addressed. 

Mr. BILIRAKIS. Thank you for your testimony. I appreciate it. 

Now I will recognize Sheriff Nocco for 5 minutes. 
33 

STATEMENT OF SHERIFF CHRIS NOCCO, PASCO COUNTY 

SHERIFF’S OFFICE 

Sheriff NOCCO. Thank you. 

Chairman Bilirakis, Ranking Member Richardson, committee 

Members, thank you for your time. 

On behalf of the Pasco Sheriff’s Office and the citizens of Pasco, 

Florida, I would like to thank Chairman Bilirakis for the invitation 

to testify today on the needs and countermeasures for first responders to a CBRNE attack. Although some may not believe that 

this is a clear and present threat to our community, those of us 

who are on the front lines of law enforcement truly understand the 

gravity of the risk. Pasco County encompasses 745 square miles 

and has an estimated population of 480,000. This does not include 

our seasonal residents. Pasco is in the heart of the Tampa Bay region in proximity to the city of Tampa and the coastline along the 

Gulf of Mexico. What I am about to describe is not unfamiliar to 

many mid- and large-sized agencies but describes the Pasco Sheriff’s offices. 

The consequences of a CBRNE emergency will stretch our response and recovery capabilities. No matter the nature of the severity of a CBRNE event, it will be the local first responders who 

will provide the initial operational response and oversee crisis management. The Pasco Sheriff’s office is primary provider of law enforcement services to 89 percent of the county and provides specialized services and mutual aid to the four incorporated citizens. We 

are the first responders at the forefront of this issue. The State of 

Florida established regional teams to respond to CBRNE incidents. 

When these teams are selected our Sheriff’s Office was not designated as part of a regional team. If a large-scale CBRNE incident 

was to occur in Pasco County, we would be forced to rely upon regional State and Federal specialists for their response components 

to assist with disaster management, investigation, and to provide 

a sufficient level of emergency response. Special advice and resources would also be required as part of the recovery management 

phase, including the provision of long-term health monitoring, psychological support, building and environmental decontamination, 

re-establishing public confidence, and supporting a return to normality. 

Understanding that your time is limited and with the opportunity to speak with you today, I would like to take a few moments 

to explain the concerns of the Pasco Sheriff’s Office. These recommendations and thoughts are intended to convey the perspective 

not only of law enforcement executive but those of front-line deputies. Caches of prepositioned personnel and institutional medical 

countermeasures should be afforded to law enforcement first responders similar to the process developed for postal employees. 

Law enforcement agencies will be in the forefront of operations in 

a biological disaster, and it is critical that our personnel are available and safe to perform their duties. 

When initiating a program to distribute the anthrax vaccine for 

first responders in case of a biological attack, please allow local law 

enforcement agencies along with other emergency services a voice 

in making the decision as to who will be defined as a first responder. There are many components of our sheriff’s office that will 
34 

be in need of this vaccine besides our sworn deputies. This would 

include our communications section and medical staff in our jail, 

just to name a few. 

There are other services in our local government that would fully 

support our operations. If they do not enter a hot zone to support 

us because they are not properly vaccinated, our capabilities would 

suffer tremendously. Local law enforcement agencies deserve a seat 

at the decision table when defining the term first responder because we are the immediate boots on the ground in any situation. 

As we are discussing countermeasures, we need to mention CBRNE 

protective suits. Although every law enforcement officer should 

have a protective suit but does not at this time, we should immediately ensure our special operation units have them. SWAT and 

SERT teams across the country should be the first provided with 

protective suits and equipment to respond to a CBRNE attack. We 

often think a CBRNE attack will be a large-scale disaster affecting 

a large metropolitan area. One of the main goals of a terrorist is 

to maximize fear in a society. What greater fear and easier access 

can be achieved with minimal resources required than for a terrorist to attack a school, church, synagogue, or mall with a CBRNE 

component in their operation, such as a dirty bomb. In such an incident, this would probably include an active shooter and hostage 

situation. What greater sense of hopelessness could we have than 

if our specialty teams respond very quickly as they usually will, 

stood on the perimeter and not be able to advance in a situation 

because we are not properly prepared to go into an active situation 

that requires protective suits. 

Although this hearing is focused on countermeasures, I would be 

negligent in my duties to you, the deputies I stand with, and the 

citizens we serve if I did not raise the issue of the most critical 

piece of emergency response that is still missing today, interoperable communication. The best plans for the worst disasters are useless if we cannot communicate with each other. Today, 10 years removed from the events of 9/11, we are a country that still has not 

addressed the greatest failures, and that is the ability for all first 

responders to seamlessly communicate with each other on a secure 

frequency. 

In my humble opinion, this should remain our first priority for 

funding, for it is the catalyst for success and the response to any 

incident. The Tampa Bay region is in need of a fully interoperable 

communications system. As Federal dollars are distributed for 

homeland security issues, I would encourage you to make interoperable communication a top priority. 

I thank you for your time. I look forward to your questions, and 

may God bless all our first responders. 

[The statement of Chief Nocco follows:] 

PREPARED STATEMENT OF CHRIS NOCCO

APRIL 16, 2012 

Chairman Bilirakis, Representative Richardson, and Members of the committee: 

On behalf of the Pasco Sheriff’s Office and the citizens of Pasco County, Florida, I 

would like to thank Chairman Bilirakis for the invitation to testify today on the 

needs and countermeasures for first responders to a chemical, biological, radiological, nuclear, or explosive (CBRNE) attack. Although some may not believe that 
35 

this is a clear or present threat for our community, those of us who are on the front 

lines of law enforcement truly understand the gravity of the risk. 

Pasco County encompasses 745 square miles and has an estimated population of 

480,000; this does not include our seasonal residents. Pasco is in the heart of the 

Tampa Bay Region in proximity to the city of Tampa and a coastline along the Gulf 

of Mexico. We are a diverse community whose No. 1 economic engine is agriculture. 

In the near term, we anticipate significant growth in areas of finance, education, 

technology, and the health care industry. 

The consequences of CBRNE emergencies will stretch our response and recovery 

capabilities. No matter the nature or severity of a CBRNE event, it will be the local 

first responders who will provide the initial operational response and oversee crisis 

management. The Pasco Sheriffs Office is the primary provider of law enforcement 

services to 89% of the county and provides specialized services and mutual aid to 

the four incorporated cities—we are the first responders and at the forefront of this 

issue. 

The State of Florida established regional teams to respond to CBRNE incidents. 

When these teams were selected, our Sheriff’s Office was not designated as part of 

a regional team. If a large-scale CBRNE incident was to occur in Pasco County we 

would be forced to rely upon regional, State, and Federal specialist response components to assist with disaster management, investigation, and to provide a sufficient 

level of emergency response. Specialist advice and resources would also be required 

as part of the recovery management phase, including the provision of long-term 

health monitoring, psychological support, building and environmental decontamination, re-establishing public confidence and supporting a return to normality. 

Understanding that your time is limited and with this opportunity to speak with 

you today, I would like to take a few moments to explain the concerns of the Pasco 

Sheriffs Office. These recommendations and thoughts are intended to convey the 

perspective not only of a law enforcement executive, but those of a front-line deputy. • Caches of pre-positioned personal and institutional medical countermeasures 

should be afforded to law enforcement first responders similar to the process developed for postal employees. Law enforcement agencies will be in the forefront 

of operations in a biological disaster and it is critical that our personnel are 

available and safe to perform their duties. • When initiating a program to distribute the anthrax vaccine for first responders 

in case of a biological attack, please allow local law enforcement agencies, along 

with other emergency services, a voice in making the decision as to who will 

be defined as a ‘‘first responder’’. There are many components to our Sheriff’s 

Office that will be in need of this vaccine beyond our sworn deputies. This 

would include our communications section and the medical staff in our jail to 

name a few. There are other services in our local county government that would 

fully support our operations and if they do not enter a ‘‘hot’’ zone to support 

us because they are not properly vaccinated, our capabilities would suffer tremendously. Local law enforcement agencies deserve a seat at the decision table 

when defining the term ‘‘first responder’’ because we are the immediate boots 

on the ground in any situation. 

• As we are discussing countermeasures, we need to mention CBRN protective 

suits. Although every law enforcement officer should have a protective suit, but 

does not at this time, we should immediately ensure that our special operation 

units have them. SWAT (Special Weapons and Tactics Team) and SERT (Special Emergency Response Team) teams across the country should be the first 

provided with protective suits and equipment to respond to a CBRNE attack. 

We often think a CBRNE attack will be a large-scale disaster affecting a large 

metropolitan area. One of the main goals of a terrorist is to maximize fear in 

a society. What greater fear and easier access can be achieved with minimal resources required than for a terrorist to attack a school, church, synagogue, or 

mall with a CBRNE component in their operation, such as a dirty bomb? In 

such an incident, this would probably include an active shooter/hostage situation. What greater sense of hopelessness could we have than if our specialty 

teams, who can arrive on the scene quickly, stood on the perimeter not able to 

advance into the situation because we are not properly prepared to go into an 

active situation that requires protective suits? 

Although this hearing is focused on countermeasures, I would be negligent in my 

duties to you, the deputies I stand with, and the citizens we serve if I did not raise 

the issue of the most critical piece of emergency response that is still missing today: 

Interoperable communication. The best plans for the worst disasters are useless if 

we cannot communicate with each other. Today, 10 years removed from the events 

of 9/11, we, as a country, have not fully addressed one of our greatest failures and 

that is the ability of all first responders to seamlessly communicate with each other 
36 

on a secure frequency. In my humble opinion, this should remain our first priority 

for funding, for it is the catalyst for success in the response to any incident. The 

Tampa Bay Region is in need of a fully interoperable communication system. As 

Federal dollars are distributed for homeland security issues, I would encourage you 

to make interoperable communication the top priority. 

Thank you for your time and your consideration of these concerns. May God continue to bless the men and women of the Pasco Sheriffs Office and all first responders throughout America. 

Mr. BILIRAKIS. Thank you. Thank you very much. 

Now I will recognize Mr. Peralta for 5 minutes. 

STATEMENT OF MANUEL L. PERALTA JR., DIRECTOR OF SAFETY AND HEALTH, NATIONAL ASSOCIATION OF LETTER CARRIERS 

Mr. PERALTA. Good morning, Chairman Bilirakis, Ranking Member Richardson, and the Members of the subcommittee. 

My name is Manuel Peralta, and I am the director of safety and 

health at the National Association of Letter Carriers. It is an honor 

to provide information about how letter carriers are bolstering our 

National security by participating on a voluntary basis in a program to distribute medicines to Americans in the event of a biological attack. I will be brief because you are busy and because we 

have mail to deliver. Six days a week, letter carriers deliver mail 

to more than 150 million homes and businesses throughout this 

country, and today is no exception. 

In December 2003, just 2 years after the worst terrorist attack 

in American history, President George W. Bush asked the United 

States Postal Service to consider delivering antibiotics to residents 

of large metropolitan areas following the release of a biological 

agent. President Bush and his homeland security advisors knew 

that no other entity had a network capable of carrying out such a 

mission. He knew further that letter carriers who are regularly 

named by the American people as the most trusted Federal employees, who are ideally suited for such a complex task. 

On February 18, 2004, the Secretaries of Health and Human 

Services and Homeland Security, along with the Postmasters General signed a memorandum of agreement to establish policies and 

procedures. The result is the City Readiness Initiatives Postal 

Plan, a Federal program led by HHS and designed to help major 

cities respond to a large-scale public health emergency and avert 

mass casualties by dispensing antibiotics to the population within 

48 hours. President Obama confirmed the value and the bipartisan 

nature of this postal initiative through his Executive Order of December 2009. This order enacts recommendations inspired by the 

September 11 commission. Both Presidents responsible for protecting the American people knew that no one goes to every address in America 6 days a week, and no one knows the neighborhoods, like letter carriers. 

To date, six communities have become involved: Seattle, Minneapolis, Louisville, Philadelphia, Boston, and San Diego County 

with the cities of Vista and San Marcos. Each program involves intensive planning and the participation of various Federal agencies. 

But one constant is the role of letter carriers. We look upon this 

not as a chore but as another form of service. The Nation’s letter 

carriers, who I am privileged to serve as an elected officer of the 
37 

NALC take seriously our role embedded in the Constitution of providing universal mail service to every corner of this country, binding this vast land together and unifying individual communities; 

all this without a dime of taxpayer money. 

We take equal pride in serving our communities in other ways, 

whether conducting the Nation’s largest single-day food drive, as 

we do every May, watching out for the elderly on our routes, rescuing someone who has fallen or taken ill, locating a missing child, 

putting out a fire, or even stopping a crime. 

Service and protection come naturally to letter carriers, onequarter of whom are military veterans and who are glad to volunteer for their country once again, and all of whom have an affinity 

for the people in the neighborhoods they serve. The timing of today’s hearing is fortuitous because of the exercise held last 

Wednesday in Louisville, which involved a contaminated truck containing a biological agent and the response of Federal, State, and 

local officials. Allen Harris, president of NALC Branch 14 in Louisville, reports with pride that several officials went out of their way 

to praise the dedication and energy with which letter carriers are 

engaged in this effort and that 60 percent of the letter carriers in 

Louisville volunteered, 323 men and women. Allen, himself an Air 

Force veteran, attributes this in part to the large number of military veterans in his branch. As Brother Harris puts it, they already 

know what it is to serve their country. More broadly, he says, the 

extraordinary level of participation reflects the sense of commitment all his letter carriers have to the neighborhoods they serve. 

‘‘It just makes sense; it makes you feel very proud,’’ Allen said, 

‘‘because you are doing something that is going to help the community. I have been on my route for 28 years. I have seen kids born, 

go to college, come home, and start their families.’’ 

Under the Louisville plan, letter carriers would deliver medicines 

to 750,000 people. Letter carriers would load 670 cases of medication into 2-ton vehicles from a depository to which the Federal Government would fly the medicines. Every home would receive two 

bottles of medication containing 20 pills apiece along with a flyer. 

I might add, this type of planning is nothing new to the Postal 

Service or to letter carriers. Indeed, it is one of the factors that led 

a recent British study to name the Postal Service as the world’s 

most efficient system. In fact, Cities Readiness Initiative is one 

more example of the value of the unique universal network that it 

is and must remain the hallmark of the United States Postal Service. 

In closing, let me say that we are fully aware of the solemn responsibility we bear as the foot soldiers for this critical homeland 

security program, whether in Boston, Philadelphia, Minneapolis, or 

elsewhere. It is a duty we readily accept. We appreciate the confidence placed in us by Presidents and Homeland Security officials 

from both parties. We are continually training and preparing to 

justify that confidence. Thank you for your attention and thank you 

for your service to our country. 

[The statement of Mr. Peralta follows:] 
38 

PREPARED STATEMENT OF MANUEL L. PERALTA, JR. 

APRIL 17, 2012 

Good morning, Chairman Bilirakis, Ranking Member Richardson, and other Members of this very important subcommittee. My name is Manuel L. Peralta Jr., and 

I am the director of safety and health at the National Association of Letter Carriers. 

It’s an honor to have the opportunity to provide you with some information about 

how letter carriers are bolstering our National security by participating—on a volunteer basis—in a program designed to provide medicines to Americans in the event 

of a biological attack. 

Our participation in today’s hearing is timely, because just last week we conducted a table-top exercise for the Cities’ Readiness Initiative in Louisville, Kentucky. 

I will be as brief as I can, so that panel has the appropriate time needed to ask 

questions—and also because there is mail to deliver today. Six days a week, the letter carriers of the U.S. Postal Service deliver mail to more than 150 million homes 

and businesses throughout this country, providing the world’s best and most affordable delivery service—and today is no exception. 

First, let me provide an historical overview of our involvement with this program. 

In December 2003, just 2 years after the worst terrorist attack in American history, 

President George W. Bush asked the U.S. Postal Service to consider delivering antibiotics to residents of large metropolitan areas during catastrophic incidents—specifically the outdoor release of a biological agent. 

President Bush and his homeland security advisers knew that no entity besides 

the Postal Service had an existing network in place that would be capable of carrying out such a mission. He knew further that letter carriers, who among other 

things are regularly named by the American people as the most-trusted Federal employees, were ideally suited for such a critical and complex task. 

On Feb. 18, 2004, the Secretary of Health and Human Services, the Secretary of 

Homeland Security and the Postmaster General, signed a memorandum of agreement to establish policies and procedures for U.S. Postal Service distribution of oral 

antibiotics in response to a biological terrorism incident. 

The result is the Cities’ Readiness Initiative—a Federal program led by HHS and 

designed to help major U.S. cities increase their capacity to respond to a large-scale 

public health emergency and avert mass casualties by dispending oral antibiotics to 

the population within 48 hours. 

President Obama further confirmed the value—and the bipartisan nature—of this 

initiative, through his Executive Order of Dec. 30, 2009, which directed the establishment of a Federal capacity through the U.S. Postal Service for the timely residential delivery of medical countermeasures following a biological attack. This Executive Order enacts recommendations made by the Commission on the Prevention of 

Weapons of Mass Destruction Proliferation and Terrorism, an outgrowth of the September 11 Commission. 

Both Presidents, responsible for protecting the American people, knew no other 

agency is capable of doing this—because no one else goes to every address in America, 6 days a week. Further, no one knows the neighborhoods like the letter carriers. 

To date, seven cities in six metropolitan areas have become involved in this effort—Seattle, Minneapolis, Louisville, Philadelphia, Boston, and San Marcos and 

Vista both within the county of San Diego. They are in varying stages of preparation. Each program involves a great deal of planning and the participation of a variety of State, local, and Federal agencies—but one constant is the role of the letter 

carriers, who are essentially where the rubber hits the road. 

We are glad to volunteer for this mission, and to accept the somber responsibility 

that comes with it. We look upon this not as a chore, but as another form of service. 

The Nation’s letter carriers, whom I am privileged to serve as an elected officer of 

the National Association of Letter Carriers, take seriously our role, embedded in the 

Constitution, of uniting the country by providing universal mail service to every corner of this country, binding this vast land together and unifying individual communities. All this, without using a dime of taxpayer money. 

And though it is not a term and condition of our employment, we take equal pride 

in serving our communities in other ways as well, whether conducting the Nation’s 

largest single-day food drive, watching out for the elderly on our routes—or occasionally finding ourselves in the position of rescuing someone who has fallen or 

taken ill, locating a missing child, putting out a fire, or even stopping a crime. 

In that spirit, we are particularly gratified to be able to serve our county in the 

program I am discussing today. It is a plan to which we are committed and for 

which we are ready. Why is that? Because service and protection come naturally to 
39 

letter carriers, one-quarter of whom are military veterans and are glad to volunteer 

for their county once again—and all of whom have an affinity for the neighborhoods 

they serve, their customers, and the families they watch grow over the years. 

I mentioned that the timing of today’s hearing is fortuitous, because of the exercise held just last Wednesday, which made Louisville the second city, after Minneapolis, to be formally designated as a pilot city in the Cities’ Readiness Initiative. 

This followed the March 21 signing ceremony at Louisville City Hall with top officials. The president of NALC Branch 14 in Louisville, Allen Harris, took part in the 

7-hour exercise, which involved a contaminated truck containing a biological agent. 

He did so along with Federal, State, and local officials from the FBI, county sheriff’s 

departments, city and suburban health departments, postal inspectors, police departments, Health and Human Services, and other agencies. 

Allen reports, with much pride, two things I will share with you. One is that a 

number of these officials went out of their way to praise the dedication and energy 

with which the letter carriers are engaged in this effort. The second is that 60 percent of the letter carriers in the Louisville branch of the National Association of Letter Carriers signed up—323 men and women out of 573—to undergo the training, 

and deliver the medicines if and when needed. That is in part due to the large number of military veterans in the branch, according to Allen, himself an Air Force veteran. As Brother Harris put it, ‘‘They already know what it is to serve their country.’’ 

More broadly, he says, the extraordinary level of participation is attributable to the 

sense of commitment all his letter carriers have to the neighborhoods they serve. 

‘‘It just makes you feel very proud,’’ Allen said, ‘‘because you’re doing something 

that’s going to help the community. I’ve been on my route 28 years. I’ve seen kids 

born, go to college, come back home to start their families. It’s almost like you’re 

a part of their family.’’ 

Already, Branch 14’s union hall has been used some 10 times by Louisville authorities for training and meetings, because it can accommodate up to 220 people. 

Under the Louisville plan, letter carriers would deliver medicines to 750,000 people 

in 225,000 households in the city and suburbs in the event of a biological incident. 

Letter carriers would load 670 cases of medication into each of their 2-ton vehicles, 

from a depository to which the Federal Government would fly the medicines. There 

are 48 bottles of medicine per case. Every home will receive two bottles of medication containing 20 pills apiece, along with a flyer. That has two advantages—it 

makes distribution simpler and faster, and it also staggers the times residents 

would return to get more medicines. 

I might add that this type of planning is nothing new to the Postal Service or 

to letter carriers—indeed, it is one of the factors that led a recent British study from 

Oxford to name the U.S. Postal Service the most efficient in the world. In fact, the 

Cities’ Readiness Initiative is one more example of the value of the unique universal 

network that is—and must remain—the hallmark of the United States Postal Service. 

In closing, let me say once again that we are fully aware of the awesome nature 

of the responsibility we bear as the foot soldiers for this critical homeland security 

program, whether in Louisville or Boston, San Diego or Minneapolis, or elsewhere. 

It is a responsibility we readily and fully accept. We appreciate the confidence 

placed in us by Presidents and homeland security officials from both parties—and 

we are continually training and preparing to justify that confidence. 

Thank you for the opportunity to testify today. I would be happy to answer any 

questions you may have. 

Mr. BILIRAKIS. Thank you. Thank you for your service to our 

country. Also I thank you for your testimony and thanks for your 

patience. I will go ahead and get started. I will recognize myself 

for 5 minutes for questions. 

For all the witnesses, I am interested in your use of rapid diagnostic capabilities. Good diagnostics, whether through physical 

exam or through a piece of technology, are indispensable to providing appropriate care, in my opinion. Diagnostic devices are also 

considered medical countermeasures by BARDA. How important 

are rapid point-of-care diagnostics to the first responder community? Would it be useful if you had quick, easy-to-use diagnostics 

or biological or chemical threats to help inform your response? 

Whoever would like to go first. 
40 

Chief GILLESPIE. Mr. Chairman, thank you for the opportunity to 

address that question. 

I have got to say, it is extremely important for us to use all the 

tools that we have available to us to help determine the safety of 

our citizens and the safety of our responders. I can say that what 

has happened over the last 20 years, last 10 years particularly, 

from my point of view in the fire services is we have made huge 

strides. We have made tremendous leaps in our ability to recognize 

a problem and how we deal with that. Much of that happened post9/11, and we made a lot of changes in how we approach a situation. 

We know that we can’t rush into every particular situation. The 

sooner we can get in, the sooner we can get in, the sooner we can 

deal with the problems. So, with immediate diagnostic equipment, 

whether it be skills or technology, it certainly is important to us. 

I will give you a quick example: We responded in the Las Vegas 

valley to a ricin incident. Maybe you didn’t hear about it. That is 

because none of the first responders, none of our public were injured or killed because of that particular incident. Because our first 

responders were able to determine that they had a serious problem 

that may be of a chemical-biological type-nature. The person who 

was doing that died from their exposure to the products but none 

of our responders were because they were able to diagnose this 

early on and keep from becoming contaminated at the scene. 

Sheriff NOCCO. Thank you, Chairman. 

I concur. Any time we can be proactive instead of reactive is 

going to make us safer. Going back to anecdotes, our agricultural 

unit has detector devices out there in the field, and we were able 

to detect—it was actually a dentist office that had abandoned their 

location. However, with the X-ray machine, there was small chemicals or radiological materials still left behind. The place had been 

abandoned. Because of the detection devices, we were able to be 

proactive out there and remove it. 

So I concur that anytime we can be proactive out there, it is 

going to be beneficial for us. Along with what the chief said, it is 

the training aspect of it. The more training we can provide our first 

responders, the better they are going to be. We can give them all 

the equipment they need, but it is the training that is going to 

make them safer. 

Mr. BILIRAKIS. Would anyone else like to respond? 

Mr. LOCKWOOD. Yes. Just as the technology with your cell phone, 

the devices and items that we utilize continually change and the 

technology continues to improve. As we continue to watch grant 

dollars continue to dwindle, it becomes more and more difficult to 

stay current with those technologies because they are not exactly 

cheap as they roll out the new technology. So I think that those 

diagnostics, whether it be the training or the new tools that we are 

provided, we have to be looking at, are they being considered 

sustainment costs? Or are they being considered a new technology 

that allows us to do a better job of meeting the needs of our communities? 

Mr. BILIRAKIS. Thank you. All right. We will move on. 

This question is for Chief Gillespie. Your testimony cites some 

important concerning studies about the availability of the first responder workforce during a pandemic. One study you mentioned 
41 

found that only 49 percent of survey participants would be both 

willing and able to respond, and the other found that 80 percent 

would not report for duty in the absence of personal protective 

equipment or vaccination. We shouldn’t have to ask responders, in 

my opinion, to make a choice between doing their job and protecting their own health and that of their families. 

Given that antibiotics and vaccines are plentiful, it should be a 

fairly easy to lift to help responders—and I know you all agree— 

to achieve the peace of mind they need to help them do their job. 

Why has this taken so long? What is your opinion on this? What 

do you think the barriers to reaching this desire in State are, and 

is it a matter of cost? I think not. Or is it a matter of culture? I 

would like to hear from Chief Gillespie and anyone else wishing to 

respond. 

Chief GILLESPIE. Mr. Chairman, thank you for the question. 

What do I think the cause of this is? From my opinion, probably 

over-analyzation. 

I have got to say that our people very much understand the nature of the problems that we have out in the field. If somebody has 

the ability to provide us a tool to perform our jobs, to be able to 

protect our citizens and protect ourselves and our families, I just 

don’t understand why there would be any reason to delay this. I 

just don’t get that at all. 

I am from the Las Vegas area. So I am going to use a Las Vegas 

analogy here for you. Every day that goes by is going to have a cost 

to it. It is like rolling the dice. You roll the dice in Vegas, and 

sometimes you win. But sometimes you lose. Every day that goes 

by, we are taking that chance that our first responders won’t need 

those things that are available to us today. So it is very frustrating 

when we hear that it is there. It is available. It just hasn’t been 

delivered to us yet. 

Mr. BILIRAKIS. Appreciate it. If anyone else wishes to add something? Okay. Thank you. 

I will now recognize our Ranking Member for 5 minutes or so. 

We are going to try to do a second round. 

Ms. RICHARDSON. Mr. Peralta, it is good to see you again, sir, as 

always. Can you describe for us—I thought it was interesting you 

didn’t mention in your testimony—the potential impacts that are 

being imposed on the Postal Service, how you would view those impacts or changes, how that could impact your ability to effectively 

participate in this model? 

Mr. PERALTA. Example: The elimination of door-to-door delivery 

letter carriers would no longer be able to deliver the product, the 

medicine, to your home. As there is some legislation that proposes 

to have centralized delivery at the end of the neighborhood. If I am 

delivering the product to you at your home, you don’t have to leave 

your home to get that medication. If I have to put it at the end of 

the street in a cluster box—picture yourself in our gray years of life 

taking that walk, fearful, wondering what is going on, to get my 

meds. Put it at my doorstep. Let us serve America at your porch. 

Ms. RICHARDSON. Thank you, sir. 

My next question also for you is, the anthrax attacks in 2001 

were particularly harmful for many of our postal workers. I was cu-
42 

rious, are there any lessons learned that you have been able to 

take that would also apply to this program as well? 

Mr. PERALTA. In 2001, one of my predecessors, Al Ferranto, was 

the director of safety and health. At that time, the Postal Service 

very actively got involved in briefing the NALC, keeping the NALC 

informed and in the loop as to what was going on and literally trying to make sure that we are not exposing ourselves to any type 

of a hazard, nor the American people to any type of a hazard. 

We needed to make certain that the mail was safe to deliver. As 

a result of that, there has been a lot of technology applied, radiation to protect against the anthrax in the mail. The lesson learned 

is, we have to work together, all of us, to protect America. 

Ms. RICHARDSON. Thank you, sir. 

My last question here for you: Are there any resources or additional support that you would feel that the letter carriers would 

need to fulfill this assignment? 

Mr. PERALTA. I think it leaves the question to be answered by 

the experts. How more do we protect the first responders? The 

speakers at this table, this panel, speak very importantly of the 

need to protect those first responders. Whatever is learned needs 

to be passed on to all those first responders. 

Ms. RICHARDSON. Are you guys at all currently included in any 

first responder discussions? 

Mr. PERALTA. We are involved in our element of the plan. We are 

briefed as to where we are going, what new cities we are rolling 

it out in. Then the membership is informed that we are not going 

to be put at risk as first responders until the experts detect that 

it is safe to start the delivery of the antibiotics to the community. 

Ms. RICHARDSON. But I mean, other than this particular program, have the letter carriers ever been included in first-responding situations or—— 

Mr. PERALTA. I apologize. I cannot answer that. I don’t have a 

recollection off the top of my head. 

Ms. RICHARDSON. Okay. If you could supply that to the committee, that might be helpful. 

My next question is for Mr. Lockwood. Over the past 2 years, 

Homeland Security grant programs have been dramatically reduced. Can you discuss how cuts to the grant funding has affected 

the first responders’ ability to do training and acquire necessary 

equipment? Because that will be something that we are going to be 

voting on very shortly. 

Mr. LOCKWOOD. Obviously, any time we lose any funding, it 

makes an impact. But in the first years of the grants, obviously, 

we saw a rollout of a lot of equipment. The issue is that, as I stated 

before, we have the issues of maintenance or replacement of equipment that we have purchased over the course of time. Then there 

is the additional training that goes along with that. Some of the 

areas that we have provided equipment and training to are not 

things that we necessarily do on a daily basis so that the currency 

requirements for training is more because it is not a daily handson activity that somebody may be dealing with. So we are constantly having to try to make decisions about how to do more with 

less. 

Ms. RICHARDSON. Okay. Thank you for your answer. 
43 

My last question would be to the four of you. Is there anything 

that you would like—we have the ability after a hearing to forward 

additional questions to the panel. Are there any questions—I always hate when we have two panels because you don’t really get 

an opportunity to say, wow, you know, they should have asked this 

question. Is there any question that you would like us to ask Panel 

I that would be helpful on your behalf? 

We can start here with you, Chief Gillespie. 

Chief GILLESPIE. Thank you, Mr. Chairman and Ranking Member. I would say—not that I have a question for the panel. We have 

already stated forth the charges that we need help from you, as 

Members of Congress, to provide services to our citizens. 

But I want to say thank you, also. You end up listening to a lot 

of folks here many times, I am sure just asking. I want to say 

thank you for the opportunity that I have to be here and be 

participatory in some of the major things that Members of Congress have done for the emergency services. I will state specifically 

the D band broadband network issue. Thank you so much for what 

happened with that. You heard some of our problems down here 

down the road on interoperability. That is just a small tip of the 

iceberg. Thank goodness we have the opportunity to deal with it, 

though. It is going to take a little time. We have got to plant the 

trees to make the shade for later in the future, but at least we are 

on the right track. Thank you for that. 

Ms. RICHARDSON. Sure, thank you. 

Mr. LOCKWOOD. Mine I guess is not so much a question but a 

statement. I would like, as we look at this specific topic going forward with medical countermeasures, to get the message across that 

not necessarily does one size fit all and that we have got to be open 

to new methodologies and processes that will allow us to move forward and advance. We find that there are days where we are so 

ingrained in the processes that we are in, that we struggle with 

trying to find better ways to do things. 

Ms. RICHARDSON. Thank you. 

Sir, you are up for your first-year anniversary in the job. 

Sheriff NOCCO. Yes. It has been a long year. One comment. Mr. 

Polk brought up a very good point. He said, a voluntary program. 

There is the anthrax vaccine. It is five shots over 18 months. I 

would encourage that to continue to be voluntary. There was a 

study done that—Florida was included in the study—that 64 percent of law enforcement officers are willing to take this vaccine. I 

think as long as it is voluntary—there is a lot of education done 

for it—then we will get even more participation. So I would think 

that when you mandate things, I think people get scared and they 

get reluctant. When it is a voluntary program, people are more 

willing, and I think the educational component is huge for the success. 

Ms. RICHARDSON. Thank you. 

I yield back. 

Mr. BILIRAKIS. Okay. I will recognize myself for 5 minutes or so. 

You are welcome to stay. I think we still have some time for some 

more questions. 

This one is for the sheriff, your county being right outside of 

Tampa. As a major city and one that receives funding through the 
44 

Cities Readiness Initiative, Tampa no doubt has plans that it has 

exercised to receive National medical supplies and dispense them 

to the public. Given your proximity to Tampa, has the Department 

of Health and Human Services engaged you in any of this planning? Do you feel that your role and the expectations of your personnel are clear when it comes to distribution and dispensing of 

medical countermeasures in or around the Tampa area? 

Sheriff NOCCO. Thank you for your question, Chairman. To be 

blunt about it, our members are not in the circle. I can tell you, 

our emergency operation center, which is not under the Sheriff’s 

Office, may be involved. But directly our Sheriff’s Office has not 

been at the table. The city of Tampa and the county of 

Hillsborough are doing a very good job putting our efforts together. 

As we proceed, the Pasco Sheriff’s Office is a willing participant. 

The city of Tampa is utilizing our our resources. We are sending 

our people down for possible demonstrations. We are sending them 

for mass arrests. We are working that in conjunction. But as to a 

distribution, if an outbreak was to occur, no. I can also tell you 

very bluntly that our deputies do not have the equipment to respond if such an incident occurred, God forbid an anthrax or any 

type of chemical or biological attack occurred while our deputy is 

on the front line, they would not have protection. 

Pasco County, as you know, is literally 10 minutes outside the 

city of Tampa at points. We have major critical components that 

are going to be involved with the RNC that are secondary locations, 

and unfortunately, we do not have the equipment nor have we received any of the funding. We are working with the city of Tampa. 

However those types of conversations we have not been a part of. 

Mr. BILIRAKIS. Well, that is unfortunate. We have to do something about that. 

This next question is for Mr. Lockwood. I am interested in your 

perspective on the consolidation of grant programs and the impact 

that it has on projects with a medical focus, such as those previously funded by the MMRS. Then, has your ability to maintain 

and sustain the medical preparedness capabilities you previously 

attained using grant funds been impacted? What is the proper balance, in your opinion, between infusions of Federal versus State or 

local funding? I know you have a lot of interest in this. 

Mr. LOCKWOOD. Well, MMRS is clearly one of the areas that supports us specifically in the first responder community with the—at 

least in our area, we have some prepositioned countermeasures 

that are available to our first responders. The problem with those, 

obviously, become—there is a replacement cost. There is a cycle 

where those medications will expire, as with all the other medications. 

I think that one of the other issues is that as this consolidation 

process takes place, it is more like a block grant program. While 

they will say it is more flexible, it is actually less flexible in the 

sense of we see a degrading of some of the programs we have been 

able to put together. There will be programs in my anticipation 

across this country that have been built and, at the end of this, 

may no longer be I believe to sustain their operations based on just 

the way the new structuring has taken place related to the consolidation. 
45 

I do also want to point out that there is the 16 grants, but there 

is also the HHS grants for public health preparedness, et cetera. 

One of the problems we have had in this process is the coordination 

between the two of those. We understand that that is being taken 

care of in this next grant cycle. We may have one guidance under 

DHS aside telling us we need to do something, but then there is 

conflicting language related to what is in the CDC public health 

preparedness or ASPR grants. 

But I do see that going forward, we are going to continue to meet 

challenges in our ability to meet not only the first responders’ abilities from a medical countermeasures standpoint, but I think that 

we are going to have these same problems related to communitybased programs. 

Mr. BILIRAKIS. Thank you. 

Chief, in the absence of a dedicated med kit, one option to provide pre-event planning for the first responders is to establish a 

dedicated local cache or stockpile. Is a cache approach a decent alternative to med kits? Have you established such a cache in your 

city? Anyone else want to respond on this, your feelings on this? 

What do you think, is it a good alternative to a med kit? 

Chief GILLESPIE. Mr. Chairman, first of all, we have not established one in our area. Second, it is probably better than what we 

have, which is not being included in the first tier. But certainly far 

down the list of being able to be utilized and keep our first responders in the job, responding, knowing their families and themselves are protected immediately. As you have heard, there is always a delay out there. One of the things that we have in emergency services is a lack of time. Time is important to us. That is 

how we measure our success in many ways is how quickly we can 

respond and how effectively we respond. 

Every second that goes by, when we have to go chase down something or we have to go to a different location, it makes it more difficult for us to meet those time requirements. So while it is better 

than not having something available, it is not an ideal situation for 

us. 

Mr. BILIRAKIS. Thank you. 

Sheriff. 

Well, whoever would like to respond. 

Mr. LOCKWOOD. I just wanted to state that we do have some 

prepositioned cache in the greater Hartford area. But one of the 

things that I have talked about this on more than one occasion is 

the three-event theory; that is, there is the event. Our secondary 

event is our ability to distribute our medications under that guidance that we were given to first responders before opening the public pod. Then there is the third tertiary event of actually distributing to our general public. 

The problem becomes—is that there is a 12-hour lag time most 

likely for those prepositioned medications to get to us, to get them 

out. Secondarily, now we have a resource issue of having to distribute our medications at the time of need to our first responders, 

therefore slowing the response to the third event. If we were able 

to preposition the medications in these med kits in personnels’ 

homes, we wouldn’t do away with what we would greatly reduce 

that secondary event of having to try and distribute our medica-
46 

tions, our countermeasures to our first responder community, 

therefore allowing us to get in a more rapid approach to be able 

to get to the general community in a timely manner. So while 

prepositioning is an option, and it is definitely better than what the 

current alternatives may be, the ability to close our gap to be able 

to get to the community as a whole would be best served by having 

the prepositioned kits. 

Mr. BILIRAKIS. Sheriff. 

Sheriff NOCCO. Mr. Chairman, I agree. 

There is a term that is used, keeping your head in the game. 

There is no doubt first responders are going to go in and risk their 

lives. However, there is another side of it. We are all human, also. 

We have families; we have children that we care about. When these 

situations occur, it is not going to be an 8-hour shift, then you go 

home. These are going to be days and days on end. We may never 

get back to our houses. So to ensure that our families are taken 

care of, that we don’t have to worry about their well-being, it is 

going to allow first responders to be better in their duties. It is 

going to make us better as an agency in our response to the community. So if we can have these caches in the houses, I absolutely 

agree, that is the best way to do it. If it is going to be prepositioned 

in our police stations and our fire departments and fire stations, 

that is better than nothing, as the Chief said. However, keeping 

them in our houses, being able to explain to our loved ones how to 

use them in case we are not home when a disaster occurs, I can 

tell you, it will allow first responders to be better in their duties. 

Mr. BILIRAKIS. Sheriff, a question for you and again, anyone else 

who wants to chime in. Security is a concern throughout the medical countermeasures dispensing process, whether in traditional 

pods or by going door-to-door with letter carriers. What support, financial or otherwise, does local law enforcement want from the 

Federal Government in order that you can provide the needed support to postal, public health, and other authorities involved with 

dispensing these drugs in an emergency? How can we help you? 

What support do you need from us? 

Sheriff NOCCO. God forbid this ever occur, it is not going to be 

a situation that would be isolated just to our county. As I can imagine, something like this would affect a whole region, possibly a 

State. Immediately, our resources would be drained. We would 

have to call in the National Guard. We would have to call in other 

resources to go with the mail carriers as they go house to house. 

I mean, I can’t tell you how many mail carriers we have in Pasco 

County. But with a population of over 500,000 roughly, including 

our seasonal residents, I can tell you right now that we wouldn’t 

have enough deputies to walk with them all because we have other 

concerns. You are going to have traffic issues. You are going to 

have security issues. You may have a possible crime scene that we 

are taking care of. 

When most of the time people think of a terrorist incident, it is 

one location. Now they have two or three locations possibly where 

they are going to try to spread us as thin as possible. The other 

agencies where we try to ask for mutual aid, they are going to be 

stretched just as thin. So I can tell you most importantly what we 

would need is more personnel. More personnel, the better. Then 
47 

along with personnel, we are going to need resources. You know we 

are going to need food and water. We are going to need to sustain 

ourselves. So the initial is personnel, send us bodies. After that it 

is going to continue to say, we need more food. We need clothing, 

we need things to keep us going for days and weeks. 

Mr. BILIRAKIS. Thank you. 

Last question for Mr. Lockwood. If you were to implement a voluntary anthrax vaccine program in your jurisdiction, this would require a well-organized approach and good occupational health infrastructure to achieve, given the current five-dose regimen over 

the 18 months. You mentioned that you touched on this. What options are in place to do this? 

Mr. LOCKWOOD. Well, I think that no communities are the same. 

So I can tell you that in most of our larger communities, we have 

occupational health within our municipalities or our governments 

that would most likely be able to—once given the guidance and the 

established protocols on how the program would be implemented, 

I am sure they would be able to implement it. But just like with 

anything else, we have local emergency management offices. There 

may be one individual with a community of 3,000 people, and we 

have some that have an emergency management office with 1 million people. I can’t answer the question from across the country as 

to how they would all implement it. But I would think that just 

like you—here would be my best answer: In those areas where you 

have given us the tools and we have been able to be successful with 

them, if you are able to give us this tool, I am sure we will find 

a way to be successful with it. I don’t think that should be the 

stumbling block to this. Because I think that no matter what, we 

would be able to get those programs in place because it is really 

about protecting the people that work for us. 

Mr. BILIRAKIS. Anyone else want to respond to that? First of all, 

I want to thank you all for being so blunt and frank and giving us 

all this information. This was very, very informative. But also I 

wanted to give you an opportunity to come up with—just like the 

sheriff talked about, the interoperability and then we discuss the 

grant programs. Anything else that should be on our radar screen? 

Any priorities of yours? How can we help you? I wanted to give everyone an opportunity to respond. 

Chief GILLESPIE. Mr. Chairman, thank you for the opportunity. 

One of the things that you asked here was, how could you administer a program? I can tell you that the International Association 

of Fire Chiefs is a 501(c)(3) organization that has had the opportunity to work on major programs like this across the country dealing with our entire country on intra-State mutual aid systems and 

developing programs to get them all tied together. This would be 

a great opportunity for something like our international organization to be involved in and help get this delivered out to the members of our communities, our fire service communities, around the 

country and our other responders. 

And I would also like to say that if you are looking for beta test 

groups, I can tell you that the Las Vegas valley is ready to help 

be beta test group for your anthrax vaccines and for your med kits. 

Believe me, we are ready. We believe we are on the front lines of 

and in the sights of the terrorists and anything we can do to pro-
48 

tect our people out there, we would like to do it before it happens. 

Thank you. 

Mr. LOCKWOOD. I guess my only point would be that from an 

emergency management standpoint across our Nation, we have different-sized offices, different-sized organizations. Some of these 

grant dollars are the only things keeping the doors open. I just caution that—trust me, we all know that these are difficult times and 

that we are all doing our best to do more with less. But as we have 

looked at different programs that were potentially coming out or 

cuts to programs, we may find ourselves in a situation where the 

very thing we are looking to rely on won’t be there if we continue 

to cut as deep as we are cutting. 

So I acknowledge the fact that you guys have a great deal of 

work to do, but I just caution you that at the end of the day, the 

only thing that keeps our lights on in some places are some of the 

minimal funds that we actually do see. 

Sheriff NOCCO. From the Sheriff’s Office standpoint where we are 

located, I go back to its interoperability; that is our No. 1 priority. 

It is almost like going back to the basics. That is a basic fundamental issue in law enforcement is to be able communicate because 

what we are talking about today is a worst-case scenario. These are 

things that we don’t even want to have nightmares about, but they 

could come true. However, from our standpoint, it is what we deal 

with every day, the disasters that are not to this scale. However, 

communication needs to be there. That is the fundamental core of 

what we do. It is how we operate, and it is how we can be successful. A perfect scenario is, the other day I was travelling down the 

road. I was in my vehicle. There was a Florida highway patrol 

trooper next to me, and there was a Tampa police officer in front 

of me. I cannot just pick up my radio and talk to them. If a robbery 

had happened or something had broken loose right in front of me, 

unless they saw it, there is no way we can immediately communicate. So I think, from our standpoint, it is going back to the basics, and it is communication. 

Mr. PERALTA. Mr. Chairman, if possible, whenever you have that 

need, include the letter carriers and Postal Service. 

Mr. BILIRAKIS. Okay. Well, thank you very much, again. Thanks 

for making the trip and thanks for your patience, again. I guess it 

has been a couple of hours. But again, it was well worth it, as far 

as I am concerned. 

I thank the witnesses for their valuable testimony and the Members for their questions. The Members of the subcommittee may 

have additional questions for you, and we ask that you respond in 

writing. The hearing record will be open for 10 days. Again, we are 

always available for any input, any suggestions you might have. 

Without objection, the subcommittee stands adjourned. Thanks 

again. 

[Whereupon, at 4:20 p.m., the subcommittee was adjourned.] 
(49) 

A P P E N D I X 

QUESTIONS SUBMITTED BY CHAIRMAN GUS M. BILIRAKIS FOR JAMES D. POLK

Question 1a. In response to President Obama’s Executive Order on medical countermeasure (MCM) distribution, your office has taken the lead for the Department 

of Homeland Security (DHS) on the conops plan for mission-essential personnel of 

the Executive Branch. The Office of Health Affairs (OHA) has also spearheaded an 

MCM strategy for DHS employees, and oversees the purchase and storage of MCMs 

for the DHS workforce, which includes stockpiles of countermeasures. 

What is the current process for prioritizing DHS’ MCM procurement strategy? Is 

specific threat or risk assessment information utilized in procurement decisions? 

Answer. Response was not received at the time of publication. 

Question 1b. Is there a process for OHA to share lessons learned or best practices 

from developing DHS’ MCM program with other departments and agencies, or with 

first responders who may be trying to develop their own programs? 

Answer. Response was not received at the time of publication. 

Question 2a. The DHS Medical Countermeasures Program is intended to contribute to National resilience by ensuring the timely distribution of essential medical countermeasures to DHS mission-essential personnel in the event of a biological 

attack. The fiscal year 2013 budget requests $1.9 million to fund medications, training, program support, and planning activities for this program. 

What proportion of DHS mission-essential personnel is covered by currently stockpiled MCMs? 

Answer. Response was not received at the time of publication. 

Question 2b. What portion of the requested $1.9 million is intended to replenish 

expiring lots of existing stocks of MCM, and then to acquire new countermeasures? 

Answer. Response was not received at the time of publication. 

Question 2c. What proportion is designated for acquisition of new classes of 

MCMs, such as postassium iodide or influenza antivirals? 

Answer. Response was not received at the time of publication. 

Question 3. What threats should we be thinking of protecting first responders 

against, in addition to anthrax? 

Answer. Response was not received at the time of publication. 

Question 4a. Beyond that which was provided in your testimony, can you please 

provide further details about the voluntary anthrax immunization program that 

your office is developing? Specifically: 

What is the time line for implementation? 

Answer. Response was not received at the time of publication. 

Question 4b. What are the expected outcomes? 

Answer. Response was not received at the time of publication. 

Question 4c. What is the financial arrangement with the localities chosen to participate—that is, what costs will they bear, and what costs will the Department 

bear? How much will these costs total? 

Answer. Response was not received at the time of publication. 

Question 4d. If fully implemented beyond the pilot stage, will interested participants be able to use Federal grant dollars to purchase the vaccine and implement 

the program? 

Answer. Response was not received at the time of publication. 

Question 5a. A number of first responders expressed concern to the committee 

that Federal grant funding does not apply to medical countermeasure acquisition for 

local stockpiling purposes. 

Can you clarify whether this is actually the case? What exactly does the grant 

guidance say with regard to expenditures of grants on medical countermeasures, 

and which Department of Homeland Security grant programs, if any, are applicable 

for this purpose? 

Answer. Response was not received at the time of publication. 
50 

Question 5b. Has the Office of Health Affairs worked with the Federal Emergency 

Management Agency to provide guidance on the use of grant funds for medical countermeasures? 

Answer. Response was not received at the time of publication. 

QUESTIONS SUBMITTED BY CHAIRMAN GUS M. BILIRAKIS FOR EDWARD J. GABRIEL

Question 1. For the purposes of the antibiotic med-kit program that the Office of 

the Assistant Secretary for Preparedness and Response (ASPR) is developing, how 

is the term ‘‘first responder’’ defined? 

Answer. Response was not received at the time of publication. 

Question 2a. A number of first responders expressed concern to the committee 

that Federal grant funding does not apply to medical countermeasure acquisition for 

local stockpiling purposes. 

Can you clarify whether this is actually the case? What exactly does the grant 

guidance for relevant Department of Health and Human Services grant programs 

say with regard to expenditures of grants on medical countermeasures? 

Answer. Response was not received at the time of publication. 

Question 2b. In BARDA’s vision, since the antibiotic med kit for first responders 

would be a commercial kit paid for by the responders, and something that States 

or local jurisdictions would essentially take ownership of once Federally approved, 

will the current grant structure allow for the purchase of such supplies through 

Federal grant dollars? 

Answer. Response was not received at the time of publication. 

Question 3. What is the ASPR’s approach to working with the FDA and ensuring 

that the FDA understands that med kits are a first responder and an ASPR priority? How will you ensure a successful partnership? 

Answer. Response was not received at the time of publication. 

Question 4. How do you envision that the pre-attack dispensing of medical countermeasures to the first responder workforce would be tracked? What kind of guidance will your office provide to participating localities with regard to tracking who 

has received what medications, incidence of side effects, and related occupational 

health matters? 

Answer. Response was not received at the time of publication. 

Question 5. Beyond antibiotics for anthrax, what do you envision med kits for first 

responders could contain? What threats should we be thinking about for first responder protection in addition to anthrax? 

Answer. Response was not received at the time of publication. 

Question 6. How important are rapid, point-of-care diagnostics to the first responder community? Is BARDA investing in these? Please provide a list of such 

diagnostics that have been developed and/or acquired. 

Answer. Response was not received at the time of publication. 

Question 7. Can you provide a list of countermeasures and vaccines in development designed specifically to ensure the continuity of first responders, or that are 

being developed for the general public but would have collateral benefit for first responders? 

Answer. Response was not received at the time of publication. 

QUESTIONS SUBMITTED BY RANKING MEMBER LAURA RICHARDSON FOR EDWARD J. 

GABRIEL

Question 1. What specific plans have been made to protect the protectors? Can 

you provide a list of countermeasures and vaccines in development designed specifically to ensure the continuity of emergency services? 

Answer. Response was not received at the time of publication. 

Question 2. When can an FDA-approved med kit be distributed to emergency services providers? 

Answer. Response was not received at the time of publication. 

Question 3. Following the request from OHA for resources to protect the Federal 

workforce with countermeasures, can HHS specify what resources have been deployed to protect local and State responders? What plans are in place for this protection? 

Answer. Response was not received at the time of publication. 

Æ