[House Hearing, 107 Congress]
[From the U.S. Government Publishing Office]
COMBATING TERRORISM: FEDERAL RESPONSE TO A BIOLOGICAL WEAPONS ATTACK
=======================================================================
HEARING
before the
SUBCOMMITTEE ON NATIONAL SECURITY,
VETERANS AFFAIRS AND INTERNATIONAL
RELATIONS
of the
COMMITTEE ON
GOVERNMENT REFORM
HOUSE OF REPRESENTATIVES
ONE HUNDRED SEVENTH CONGRESS
FIRST SESSION
__________
JULY 23, 2001
__________
Serial No. 107-99
__________
Printed for the use of the Committee on Government Reform
Available via the World Wide Web: http://www.gpo.gov/congress/house
http://www.house.gov/reform
U. S. GOVERNMENT PRINTING OFFICE
81-593 WASHINGTON : 2002
___________________________________________________________________________
For Sale by the Superintendent of Documents, U.S. Government Printing Office
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COMMITTEE ON GOVERNMENT REFORM
DAN BURTON, Indiana, Chairman
BENJAMIN A. GILMAN, New York HENRY A. WAXMAN, California
CONSTANCE A. MORELLA, Maryland TOM LANTOS, California
CHRISTOPHER SHAYS, Connecticut MAJOR R. OWENS, New York
ILEANA ROS-LEHTINEN, Florida EDOLPHUS TOWNS, New York
JOHN M. McHUGH, New York PAUL E. KANJORSKI, Pennsylvania
STEPHEN HORN, California PATSY T. MINK, Hawaii
JOHN L. MICA, Florida CAROLYN B. MALONEY, New York
THOMAS M. DAVIS, Virginia ELEANOR HOLMES NORTON, Washington,
MARK E. SOUDER, Indiana DC
JOE SCARBOROUGH, Florida ELIJAH E. CUMMINGS, Maryland
STEVEN C. LaTOURETTE, Ohio DENNIS J. KUCINICH, Ohio
BOB BARR, Georgia ROD R. BLAGOJEVICH, Illinois
DAN MILLER, Florida DANNY K. DAVIS, Illinois
DOUG OSE, California JOHN F. TIERNEY, Massachusetts
RON LEWIS, Kentucky JIM TURNER, Texas
JO ANN DAVIS, Virginia THOMAS H. ALLEN, Maine
TODD RUSSELL PLATTS, Pennsylvania JANICE D. SCHAKOWSKY, Illinois
DAVE WELDON, Florida WM. LACY CLAY, Missouri
CHRIS CANNON, Utah DIANE E. WATSON, California
ADAM H. PUTNAM, Florida ------ ------
C.L. ``BUTCH'' OTTER, Idaho ------
EDWARD L. SCHROCK, Virginia BERNARD SANDERS, Vermont
JOHN J. DUNCAN, Jr., Tennessee (Independent)
Kevin Binger, Staff Director
Daniel R. Moll, Deputy Staff Director
James C. Wilson, Chief Counsel
Robert A. Briggs, Chief Clerk
Phil Schiliro, Minority Staff Director
Subcommittee on National Security, Veterans Affairs and International
Relations
CHRISTOPHER SHAYS, Connecticut, Chairman
ADAM H. PUTNAM, Florida DENNIS J. KUCINICH, Ohio
BENJAMIN A. GILMAN, New York BERNARD SANDERS, Vermont
ILEANA ROS-LEHTINEN, Florida THOMAS H. ALLEN, Maine
JOHN M. McHUGH, New York TOM LANTOS, California
STEVEN C. LaTOURETTE, Ohio JOHN F. TIERNEY, Massachusetts
RON LEWIS, Kentucky JANICE D. SCHAKOWSKY, Illinois
TODD RUSSELL PLATTS, Pennsylvania WM. LACY CLAY, Missouri
DAVE WELDON, Florida ------ ------
C.L. ``BUTCH'' OTTER, Idaho ------ ------
EDWARD L. SCHROCK, Virginia
Ex Officio
DAN BURTON, Indiana HENRY A. WAXMAN, California
Lawrence J. Halloran, Staff Director and Counsel
R. Nicholas Palarino, Senior Policy Advisor
Jason Chung, Clerk
David Rapallo, Minority Counsel
C O N T E N T S
----------
Page
Hearing held on July 23, 2001.................................... 1
Statement of:
Hamre, Dr. John, president and chief executive officer,
Center for Strategic and International Studies; Frank
Keating, Governor of Oklahoma; Hon. Sam Nunn, chairman and
chief executive officer, Nuclear Threat Initiative, and
former Senator; Dr. Margaret Hamburg, vice president,
Biological Programs for the Nuclear Threat Initiative;
Jerome Hauer, managing director, Kroll Associates; and Dr.
D.A. Henderson, director, Johns Hopkins Center for
Bioterrorism Prevention.................................... 3
Harrison, Major General Ronald O., the adjutant general of
Florida; Major General William A. Cugno, the adjutant
general of Connecticut, accompanied by Major General Fred
Reese; Dr. James Hughes, Director, National Center for
Infectious Diseases, Centers for Disease Control and
Prevention, accompanied by Dr. James LeDuc, Acting
Director, Division of Viral and Rickettsial Diseases,
Director, National Center for Infectious Diseases; Dr.
Patricia Quinlisk, medical director and State
epidemiologist, Iowa Department of Public Health and former
president, Council and Territorial Epidemiologists; and Dr.
Jeffrey Duchin, Chief, Communicable Disease Control,
Epidemiology and Immunization Section, Public Health,
Seattle and King County, WA................................ 86
Letters, statements, etc., submitted for the record by:
Cugno, Major General William A., the adjutant general of
Connecticut, prepared statement of......................... 102
Duchin, Dr. Jeffrey, Chief, Communicable Disease Control,
Epidemiology and Immunization Section, Public Health,
Seattle and King County, WA, prepared statement of......... 137
Hamburg, Dr. Margaret, vice president, Biological Programs
for the Nuclear Threat Initiative, prepared statement of... 62
Hamre, Dr. John, president and chief executive officer,
Center for Strategic and International Studies, prepared
statement of............................................... 33
Harrison, Major General Ronald O., the adjutant general of
Florida, prepared statement of............................. 90
Hauer, Jerome, managing director, Kroll Associates, prepared
statement of............................................... 56
Hughes, Dr. James, Director, National Center for Infectious
Diseases, Centers for Disease Control and Prevention,
prepared statement of...................................... 110
Keating, Frank, Governor of Oklahoma, prepared statement of.. 16
Nunn, Hon. Sam, chairman and chief executive officer, Nuclear
Threat Initiative, and former Senator, prepared statement
of......................................................... 26
Quinlisk, Dr. Patricia, medical director and State
epidemiologist, Iowa Department of Public Health and former
president, Council and Territorial Epidemiologists,
prepared statement of...................................... 127
Shays, Hon. Christopher, a Representative in Congress from
the State of Connecticut, publication entitled, ``National
Security Roles for the National Guard''.................... 146
COMBATING TERRORISM: FEDERAL RESPONSE TO A BIOLOGICAL WEAPONS ATTACK
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MONDAY, JULY 23, 2001
House of Representatives,
Subcommittee on National Security, Veterans Affairs
and International Relations,
Committee on Government Reform,
Washington, DC.
The subcommittee met, pursuant to notice, at 2:35 p.m., in
room 2154, Rayburn House Office Building, Hon. Christopher
Shays (chairman of the subcommittee) presiding.
Present: Representatives Shays, Putnam, Gilman, Schrock,
Kucinich, and Tierney.
Staff present: Lawrence Halloran, staff director/counsel;
R. Nicholas Palarino, senior policy analyst; Robert A. Newman
and Thomas Costa, professional staff members; Jason Chung,
clerk; David Rapallo, minority counsel; and Ellen Rayner,
minority chief clerk.
Mr. Shays. I would like to call this hearing to order and
welcome our witnesses and guests.
A word of caution: Some of what we are about to see and
hear is not for the squeamish, but the frightening little
sickening impact of a large scale biological weapons attack on
the United States has to be confronted on its own terms. Better
to be scared by the improbable possibility than to be
unprepared for the catastrophic reality.
The focus of our hearing today is a recent terrorism
response exercise ominously named Dark Winter, during which the
unimaginable had to be imagined, a multi-site smallpox attack
on an unvaccinated American populace.
The scenario called upon those playing the President, the
National Security Council, and State officials to deal with the
crippling consequences of what quickly became a massive public
health and national security crisis.
The lessons of Dark Winter add to the growing body of
strategic and tactical information needed to support
coordinated counterterrorism policies and programs. Coming to
grips with the needs of first responders, the role of the
Governors, use of the National Guard, and the thresholds for
Federal intervention in realistic exercises vastly increases
our chances of responding effectively when the unthinkable but
some say inevitable outbreak is upon us. The costs of an
uncoordinated, ineffective response will be paid in human
lives, civil disorder, loss of civil liberties and economic
disruption that could undermine both national security and even
national sovereignty.
If there is a ray of hope shining through Dark Winter, it
is sparked by this irony. Improving the public health
infrastructure against a man-made biological assault today
better prepares us to face natural disease outbreaks every day.
Just as biotechnologies can be used to produce both lifesaving
therapies and deadly pathogens, public health capabilities are
likewise dual use, enhancing our protection against smallpox
attacks by a terrorist and an influenza epidemic produced by
mother nature.
Let me welcome and thank our most distinguished witnesses
this afternoon. Our first panel consists of key partners in the
Dark Winter exercise. We look forward to testimony from
Oklahoma Governor Frank Keating, former Senator Sam Nunn, and
their colleagues describing the critical path of decisionmaking
during a spreading public health and public safety crisis.
Witnesses on our second panel will address the important
role of the National Guard and public health personnel in a
bilateralism response.
Like politics, all disasters are local, at least initially.
State military units and public health professionals, among
others, man the first line of defense against the consequences
of a biological attack. Their perspective is important, and we
appreciate the time, talent and dedication they bring to our
discussion this afternoon.
I would like to recognize our first panel, the Honorable
Frank Keating, Governor of Oklahoma; the Honorable Sam Nunn,
chairman and chief executive officer, Nuclear Threat
Initiative, and former Senator; Dr. John Hamre, president and
chief executive officer, Center for Strategic International
Studies; Dr. Margaret Hamburg, vice-president, biological
programs for the Nuclear Threat Initiative; and Mr. Jerome
Hauer, managing director, Kroll Associates.
I think, as you know, it is our practice to administer the
oath in this committee, and I just invite you all to stand and
raise your right hands.
[Witnesses sworn.]
Mr. Shays. Thank you very much. Now, I was thinking, we
have sworn in everyone in my entire 7 years as chairman except
one person, Senator Byrd. I chickened out, Senator Nunn, when
Senator Byrd came in. But I realize that it is both an honor to
testify, I think, on this important issue and others, and I
appreciate your being willing to be sworn in.
At this time, we will start with you, Governor Keating, and
then--I am sorry, we have--you are in charge.
STATEMENTS OF DR. JOHN HAMRE, PRESIDENT AND CHIEF EXECUTIVE
OFFICER, CENTER FOR STRATEGIC AND INTERNATIONAL STUDIES; FRANK
KEATING, GOVERNOR OF OKLAHOMA; HON. SAM NUNN, CHAIRMAN AND
CHIEF EXECUTIVE OFFICER, NUCLEAR THREAT INITIATIVE, AND FORMER
SENATOR; DR. MARGARET HAMBURG, VICE PRESIDENT, BIOLOGICAL
PROGRAMS FOR THE NUCLEAR THREAT INITIATIVE; JEROME HAUER,
MANAGING DIRECTOR, KROLL ASSOCIATES; AND DR. D.A. HENDERSON,
DIRECTOR, JOHNS HOPKINS CENTER FOR BIOTERRORISM PREVENTION
Mr. Hamre. No, I am not in charge. I am just trying to stay
ahead of this bunch. That is all I'm trying to do.
Mr. Shays. Well, as far as I am concerned, you have the
floor, so you are in charge.
Mr. Hamre. Thank you. It is a real privilege. And my role
here today is really simply to summarize enough of the exercise
so that you feel you could sit in today back in the chair--when
we met about a month ago and what was going on in everybody's
head so you can appreciate the very powerful message, and if I
can ask us to go the----
Mr. Shays. Now, I understand there may be some graphic
display here.
Mr. Hamre. Sir, there will be graphics as well as some
video. This will be shown on these side monitors.
Mr. Shays. I'm told that some of it is not pleasant.
Mr. Hamre. It is not pleasant. Let me also emphasize, sir,
this is a simulation. This had frightening qualities of being
real, as a matter of fact too real. And because we have
television cameras here broadcasting, we want to tell everyone,
this did not happen, it was a simulation.
But, it had such realism, and we are going to try to show
you the sense of realism that came from that today.
Why don't we go to the next chart, if I may, please.
Well, we are--if I could, while we are waiting. Let me just
introduce and say that there were three institutions that
collaborated on this project, the Center for Strategic and
International Studies, the Johns Hopkins Center for
Bioterrorism Prevention that Dr. D.A. Henderson, who is sitting
here--Dr. Henderson, you should know as well, is one man that
is probably more responsible for eradicating smallpox than any
other person in America. And he is now----
Mr. Shays. Would you raise your hand, sir? You are the
gentleman?
Mr. Hamre. He is dedicating himself now to the protection
of the United States against these terrible diseases.
The other is the ANSER Corp. Dr. Ruth David is the
president and CEO, and she was instrumental in bringing
together so much of the resources, she and her remarkable
staff. And we are ready to go.
Let me say, Dark Winter was meant to be an exercise to see
how would the United States cope with a catastrophic event, in
this case a bioterrorism event. We thought that we were going
to be spending our time with the mechanisms of government. We
ended up spending our time saying, how do we save democracy in
America? Because it is that serious, and it is that big.
Let's go to the next chart, please. This is what we will
cover today. We will go briefly through just to say who are the
participants and the goals of the exercise, and then we also
want--quickly want to take you through the exercise itself so
that you have a chance to observe it.
We will then pull out some of the key observations, and all
of my colleagues here will be speaking to those along the way.
Next chart, please.
Mr. Shays. Dr. Hamre, may I just interrupt to welcome Mr.
Tierney, who is here.
Mr. Tierney. Sorry for the interruption.
Mr. Shays. Great to have you here. Would you just make your
first point again?
Mr. Hamre. I said, Mr. Tierney, we were delighted to be
invited to be participants here. We thought that we were going
to be getting together as a group. Everyone who was
participating in this exercise were former government
officials. Everybody had--that was the sitting at the National
Security Council had really been there before in one role or
another.
And of course we had Governor Keating sitting as Governor
Keating in the exercise. And we thought that we were really
going to get together to talk about the mechanics of
government. And what we ended up doing is saying, how do we
save democracy in America if we ever have an episode like this
that were to occur for real.
Mr. Shays. I would also welcome Mr. Gilman as well. And I
think what I will do, since they have come before you jumped
right in, to give either an opportunity to have an opening
statement, and then we will get right to your testimony.
Do you have any statement?
Mr. Tierney. No. I am happy to hear the testimony. Thank
you.
Mr. Shays. Mr. Gilman, do you have any statement?
Mr. Gilman. Thank you, Mr. Chairman. I want to thank you
for conducting this hearing at this time. Today's hearing to
examine our overall relationship between the Federal and State
governments in trying to form a cohesive and effective response
to a biological weapons attack is very timely.
For many years the possibility of a bioterrorist attack
occurring in our own Nation seemed absurd, something to be
relegated to the realm of science fiction. Sadly, events over
the last few years, with bombings occurring in New York,
Oklahoma City, have transformed the bioterrorism debate from a
question of if, to the seeming inevitably of when.
The task of developing an adequate, effective, overall
strategy to successfully counter any domestic act of
bioterrorism has proven to be a difficult challenge for Federal
and State policymakers.
Our Nation is a highly mobile society with a system of
government wherein power and responsibility are diffused
between Federal, State and local authorities. Moreover, the
American people are accustomed to an unprecedented amount of
personal freedom not found in any other nation.
All of these factors make the quick containment of any
biological attack and effective subsequent quarantining of any
affected individuals highly problematic. Indeed, primary
results from the past exercises, including one recently
concluded, have not been very encouraging.
I look forward to the testimony that our panelists will be
presenting, and particularly those who participated in the
recently held Dark Winter exercise. I am certain that their
experience and insight will prove useful to this committee as
Congress works to try to find a proper role in this emerging
and vexing problem.
Once again, Mr. Chairman, thank you for your leadership on
this important topic.
Mr. Shays. Thank you both, gentlemen, for being here. Dr.
Hamre, let me just take care of--a quorum is present. I ask
unanimous consent that all members of the subcommittee be
permitted to place an opening statement in the record, and
without objection, so ordered. And also ask further unanimous
consent that all witnesses be permitted to include their
written statements in the record. Without objection, so
ordered. And 3 days for both.
You now truly have the floor. Do you want us to dim the
lights? I am afraid to ask. I don't know if we know how to do
that.
Mr. Hamre. I leave it up to your professional staff that
has a better feel. I think that we can see it.
Mr. Shays. We'll light it.
Mr. Hamre. I also forgot to mention that this exercise,
because all of us are not-for-profit entities, was funded by
two entities. It is very important for me to say this. This was
not paid for by a contractor. This was not paid for by the
Government. This was paid for by two not-for-profit entities
that are dedicating themselves to helping protect America, the
McCormick Tribune Foundation and the Memorial Institute for the
Prevention of Terrorism in Oklahoma City.
Mr. Shays. Not to confuse you, there is a screen in front
of the desk. So we are not looking at Governor Keating and
Senator Nunn while you are showing your presentation. It is
right in front of you.
Mr. Hamre. Yes, sir. OK. So now we will proceed, if we
could, to the next one.
These are the participants, and I won't go through it here.
Everybody that we had sitting there has been in the National
Security Council for real.
Next chart, please. And we also, to add additional realism
to this exercise, we actually brought in sitting journalists.
They actually sat there to watch and participate, because a
fair amount of this exercise dealt with how we would cope with
a public campaign and explain it to the American public.
Next chart, please.
These are the five goals that we had for the exercise. This
is what we were trying to do. We were trying to figure out what
was going to be the impact on national security of a biological
attack.
We especially wanted to look at the implications for
Federal and State interactions, and this turned out to be one
of the most important elements for us to learn. And we will
bring some of this out in the lessons learned later on. But I
must tell you that there was a major divide in this National
Security Council between those who are at the national level
and those who understood the response at the State level, and
we should talk about that later.
We were especially looking at what does it take to make
these life or death decisions when we don't have enough money
for what it really takes to do it, and coping with a scarcity
of assets, and especially vaccines, was a major dimension of
the exercise. We tried to deal with the issue of information,
how do you communicate to the American public at a time of
extreme crisis, and then finally to talking about the very
tough ethical and moral issues that came from this exercise.
Let's go to the next chart. And I think this is going to
get to you to the beginning of this, the way that we
experienced it.
[Video played.]
Mr. Hamre. So when the National Security Council met this
evening, the first night of our exercise, they thought they
were getting together to talk about a crisis that was emerging
between the United States and Iraq, because we have learned of
this breaking news of a potential smallpox attack.
The President called the National Security Council
together. Fortunately, Governor Keating, who was in town
anyway, joined us for the exercise and of course for explaining
his presence, he would normally be at an NSC meeting, but he
was there that evening.
Let's go to the next chart, please. This is what happened
on the first day. This is what the NSC was learning that night.
What we were looking at--this is around December 9th--some two
dozen patients were reporting into Oklahoma City hospitals with
signs of smallpox. It was quickly spreading around the town,
and indeed the Centers for Disease Control quickly confirmed
that it was indeed smallpox.
Next chart, please. Smallpox was eradicated in the United
States in 1978--we have not had any evidence of it or at least
in--in 1949 is when it was last in the United States, but it
was eradicated 30 years ago. It is a very contagious disease
and highly lethal; 30 percent of the people that get it will
die. And once you get it, you simply have to ride it out. There
is no real therapy for it. There is a vaccine that you can
take, but you must get the vaccine before you have demonstrated
symptoms. So it is a very tough problem to work with.
Let's go to the next chart, please. These are historical
pictures of smallpox. Smallpox was the leading cause of
blindness in the world before its eradication. It is a very
ugly disease. This is, of course, in the more advanced stages
where smallpox, after the first week or so, starts forming
these pox. It is very ugly. It is at this stage where it is
highly contagious.
Next chart, please. The United States has approximately 12
million effective doses of vaccine that are available. It is
possible to administer the vaccine, but you must administer it
before you demonstrate symptoms if it is going to be effective.
In this case, we thought we had 12 million doses, but as
you will see shortly, its exposure in this exercise was in
communities where there were more than 12 million people
living.
The National Security Council, one of its initial
challenges was to decide how do we administer or strategically
how do we allocate these scarce numbers of doses to the
American public?
Next chart, please. Here is what the National Security
Council knew at the time. Again it is very--I am trying to
compress into 3 minutes what was taking 4 hours in discussion.
We clearly knew that smallpox was now being reported in
three States. It was reported in Oklahoma, in Atlanta and in
Pennsylvania. It was presumed to be a deliberate release,
because smallpox is no longer natural in the environment, and
so it was probably caused, but we did not know how.
We did know that vaccination is a source of--is one of the
tools, but the other tool is isolation, trying to prevent the
spread of the disease. We also knew at the time that Iraqi
forces were mobilizing. We did not know if these were related
phenomena, if it was at the same time being connected to the
deployment in the Persian Gulf.
We also did not have any smoking gun. We did not know who
caused it, and we had no idea where it came from. The other
thing we did not know, which was very crucial, is we had no
idea how extensive the attack was when it was unfolding.
So that first night, and we met on a Friday night,
simulating the first day of the exercise, we were really
dealing with a lot of scientific information, very little
insight into what to do about it, because we did not know where
it had been spread and how extensive the illness was already.
Next chart, please. These were the key issues that we were
looking at that first night; you know, who controls the release
of vaccine, how do you administer vaccine, who should be
getting it? How do you protect the first responders, because
you need the first responders. Who is on the front line.
I can remember Senator Nunn saying, who is on the front
line? We had national security people saying we have to reserve
doses for the military, and we had State and local responders
saying we are the front line in this war. You have got to save
us. You have got to protect us first. So it was a major debate.
So this--let's go to the next chart, please.
Now, we are going to show you a video from that first
evening as well.
[Video played.]
Mr. Hamre. Through the exercise we were introducing videos
along the way to give some sense of realism to the evening.
Now, let me--OK. Let's go the next chart if we could, please.
Here is what the Council decided on the first night. They
decided to try to accelerate the production of vaccines. There
is ongoing production, but emergency production would be
required, and you would need to waive a fair amount of
regulation. If this happened tomorrow, we would have to waive a
fair amount of Federal regulation in order to get vaccines
available on an expedited basis. That even meant 6 to 8 weeks
before we could get it.
We asked the Secretary of State to look for vaccines in
other countries. As it turns out, Russia had stocks, but there
was a question about the safety and effectiveness of those
stocks. So that was an issue that the Council had to deal with.
The National Security Council ordered a ring strategy: Try
to find people that have been affected and then inoculate the
people that are in, as it were, a circle of acquaintances
around the individual who had been infected, one of the classic
strategies for dealing with a contagious disease.
We also directed--they directed that stocks be reserved for
first responders. Because if you are expecting to see health
delivery and security in infected areas, you have to reassure
the people that have to provide that security with a vaccine,
or else they probably aren't going to do it, and you wouldn't
expect them to.
And finally they did reserve stocks for emergency break-
outs, if there were any further break-outs to occur.
Now, let's go to the next chart. Here is what was not
understood at the time of that first evening, is that the game
participants really never could see the full scope of the
initial attack because they didn't know the facts yet. They
weren't yet in.
The--that indeed the infection rate was showing up first in
the cities where you had--where it was released, and they were
released in three locations. Deliberate attack in Oklahoma,
where it was successful, and two botched attempts, one in
Atlanta and one in Philadelphia.
The participants did not know that at the time of the first
evening. So this was the scope of the infection that was not
even understood when people were having to make initial
decisions. This would be very typical of a bioterrorism
incident.
Next chart, please.
The priority was given, you know, for vaccinations and
isolation. The stocks were very inadequate given the scope of
the initial attack. Again, we didn't realize that until the
next day. But it was one of those things that was unavoidable,
and very difficult to get situational awareness, to know what
is really going on.
If there were one or two people that showed up in another
State, was that another source of an attack or was that just a
pattern of peoples' normal commerce? Remember, this occurred in
the scenario at the start of the shopping season before the
Christmas holidays. It occurred in a shopping center. And that
is why you don't know if it was a single point event or if was
widespread----
Senator Nunn. Let me add a point or emphasize this, a point
of emphasis there. If we had known for certain or even
speculated with some reasonable basis that there was a certain
area we could have isolated, then obviously whatever you needed
to do should have been done right at the beginning: Isolating
Oklahoma City, isolating parts of Georgia, whatever.
But there was no clarity. We kept asking, do we know that
it hasn't already spread all over? And the answer was, it could
have spread everywhere, because we didn't know for 10 or 12
days that it had even happened.
And those people that were in those shopping centers had
dispersed in all directions. So when you start basically
impinging on their civil liberties and telling people they
forcefully have to be kept in their homes that may have been
exposed, and when you call out the National Guard to do that,
and you at gunpoint put your own citizens under, in effect,
house arrest, and you don't even know that you are catching the
right spot or that you're dealing with the right people, it is
a terrible dilemma.
Because you know that your vaccine is going to give out,
and you know the only other strategy is isolation, but you
don't know who to isolate. That is the horror of this
situation. I just wanted to emphasize that as a point of
emphasis.
Mr. Gilman. Mr. Chairman, would you yield a moment?
How do you learn the extent of that kind of an outbreak? I
address that to Senator Nunn.
Senator Nunn. I think that Dr. Hamburg would probably be
the best one to answer that. I think an answer that night in
our exercise was we really could not.
Dr. Hamburg. You would immediately begin as you identify
cases to put together the pieces that are common in the recent
experience of the individuals who are sick and begin to do an
outbreak investigation where you can trace back to what was the
source of exposure, the common source of exposure.
And in a case like this, although we obviously didn't have
the opportunity to play all of the elements fully, that kind of
outbreak investigation would have been intensively going
forward, requiring a huge investment of trained personnel,
epidemiologists to do that medical detective work.
At the same time, since the suspicion was so high that this
was a bioterrorist event, we would also be having to have a law
enforcement criminal investigation going on at the same time
and trying to trace back to the site of exposure, which would
also be your best chance of identifying the possible
perpetrator as well.
Senator Nunn. One other point on this, right on that point.
You have got an inherent conflict between health and law
enforcement. And to the extent that they haven't coordinated
beforehand and don't know each other beforehand, before this
occurrence took place, you would have a horror show, because
law enforcement has one set of goals, health officials have
another set of goals. The President of the United States, and
Governor Keating in this case of Oklahoma, and the other
Governors would have to make a threshold decision which was
more important.
I made the decision it was health rather than law
enforcement. But that drives an awful lot of decisions. If you
don't have any advanced coordination between health and law
enforcement, you have got a huge problem. And the same thing
would be the case with health and National Guard and health and
the military. And the same thing between the whole Federal,
State, local governments. So that is a real dilemma.
Mr. Gilman. Thank you, Mr. Chairman.
Mr. Shays. Thank you.
Mr. Hamre. Let's go to the next chart there.
[Video played.]
Mr. Hamre. Let me again, Mr. Chairman, say this, that this
was a simulation, for people that may just be joining us. This
is not real, but this was something that we were simulating in
an exercise.
Mr. Shays. Still chilling.
Mr. Hamre. Here is again what the National Security Council
knew. This was the beginning of the next morning. Basically we
advanced the clock. We were now at the 6th day in the exercise.
Here is what the National Security Council was confronting,
that they had--over 2,000 people had been infected. The medical
care system had been overwhelmed.
You know, we have cut back medical care so that it is to
the least amount of excess capacity in peacetime as possible,
because we can't afford it. And of course when you have a
catastrophic event like this, it overwhelms the medical care
system very quickly for all practical purposes. Vaccine is now
gone, because you are trying to contain it in each location. It
is now in over 20 States, we are out of vaccine.
Still the Council does not know where it came from or how
widespread it is. It is clear that it was probably deliberate,
but it is unclear if this was terrorism or really an act of
war.
Let's go to the next chart, please.
[Video played.]
Mr. Hamre. Next chart, please.
Let me emphasize that this was not a game where there was a
right answer or a wrong answer. I mean, this is a case where
none of us were experiencing anything that we had ever lived
through before. So the National Security Council was coping
with very stressful situations, so please don't judge them as
to the decisions that they made. There is no right answer here,
we are all learning.
At the time the participants came to realize that it's
now--that vaccine was no longer going to be an effective
solution. We were out of it. And we now had to deal with the
issues of how do you constrain it by constraining peoples'
movement and behavior.
There was a major debate inside the National Security
Council at the time between the National Security side and the
local response side as to whether or not we should Federalize
the National Guard.
Let me ask Governor Keating to jump and speak to the issue
from a Governor who is sitting there, what he was confronting
when we had the debate in Washington over whether we should
Federalize the Guard.
Governor Keating. Well, I certainly wasn't very happy about
what those pesky Texans did to my border. But the problem
Senator Nunn said was the level of information that we had, and
the expectation of local decisionmaking and local response.
I might say that the one thing that we didn't have, because
that is the nature of the beast, was information. The first
question that was asked by us was, what is smallpox? And what
is the cure? And are there vaccines? And what do we do?
Well, for me as a Governor hearing this information,
suggested by the President, that we encourage people to remain
in their homes, that we encourage little, if any, transit
between population centers, I made a decision to close the
airports except for supplies of medical equipment and
personnel, also the roads except for supplies of medical
equipment, personnel and food and other essential items
provided the truckers are vaccinated. That was an ad hoc
decision on my part.
One of the generals at the table--this is why there was no
script whatsoever, Mr. Chairman, except the first comment that
was made right at the outset. Somebody said, what authority do
you have to do that? And I said, because I am the Governor of
my State. I am going to do it because this is how I think I
should respond to a calamity such as this.
The most important thing that we needed was information.
And obviously once that information was imparted, provided it
is able to be relied upon and it is firm and final, then
suggestions from the Federal family as to what assets and
resources would be available.
In our Federal system, with such diffuse decisionmaking,
that is crucial. What are the facts? What is the answer? What
are the resources that should--must be made available to
address it?
And obviously the comity, the information that must exist
between the Federal family and the State and local family was
essential. I was basically the skunk at the garden party. I
raised the issues of the need for bottom-up responses as
opposed to top-down responses. And sometimes I won, sometimes I
lost. But the President did an outstanding job of making sure
that I won as many times as I lost.
Senator Nunn. One added note on the Governor's comment.
When the Texas Governor--we were told the Texas Governor had
nationalized the Texas Guard and blocked the border from
Oklahoma. Well, obviously if other States around Oklahoma had
done the same thing, they would have been isolated, you
couldn't have gotten food, water, whatever they might have
needed in emergencies in there.
It had the possible result of being an absolute, total
disaster. All of my National Security Advisers, Secretary of
the Defense, and the whole team of National Security Advisers
sitting around the table advised me as President to nationalize
the Texas Guard, thereby overruling the Texas Governor.
That was a hard decision, but I decided not to do it. I
decided to get the Governor who happened to be there, but in
case if he hadn't been there, I would have gotten someone else,
or I might have called myself to try to plead with the Texas
Governor not to do that, not to have that kind of force.
But I judged that if I tried to nationalize a Guard force
that had been mobilized by their Governor to protect the
citizens of their State, in their eyes, and to protect their
own families, the worst of all worlds might be that they
basically wouldn't respond to Federal authority and then you
would have had pure anarchy. And I felt that the threshold
decision had to be made that this had to be a partnership, and
we had to go to every length to try to convince the Governor of
Texas to cooperate.
So that was the way that one was playing out. And of
course, Governor Keating, I kept sending him out of the room to
go to talk to the Governor of Texas during this whole time.
So that probably wasn't exactly realistic, but I would have
been, had he not been there, on the phone with the Governor of
Texas myself.
Governor Keating. Let me postscript what Senator Nunn said.
The challenge for me, having survived both a natural as well as
a man-made tragedy in my State, was to convince the Federal
family around that table that the best response was in fact a
local response, that the local people trusted the police chief
and the fire chief and the health officials locally. They
didn't know who these Federal people were. What we needed from
the Federal Government, from FEMA particularly, were the assets
and the assistance and, as Dr. Hamburg noticed, the facts to
permit us to respond in an intelligent and in a factual way.
We got into a--I got into somewhat of a--a friendly but
firm dialog with the military, who were--whose initial response
was, find out who did it and bomb them. Well, I don't have a
problem with responding forcefully as an American to anybody
who would do this to our States or our country.
But our challenge, and that is why I commend Senator Nunn
as President, his challenge, which he accepted, was to focus on
rescue and recovery and medical care and quarantine and
isolation and the health side, and we will take care of the bad
guys later.
And I think that is something that obviously leadership
alone will make that decision. That would not happen by
accident, and in this case he responded properly.
Senator Nunn. I do believe there are a lot of lessons to be
learned. I will just inject here one on this point. But it was
apparent to me that we needed a large group of nurses and
doctors, and we needed to bring them in from all over the
country and indeed perhaps all over the world.
The only way you can do that is probably advanced planning.
Also the question in my mind, I am not up to date on everything
the National Guard is doing in this area, but it was also
apparent to me, and the more I thought about it afterwards the
more apparent it has become, that our National Guard forces
need to be able to mobilize all of the reserve medical doctors
that they can possibly get, whether it is Guard doctors or
Reserve doctors, and even active duty officers who have medical
knowledge.
And we need to have some advanced planning on that. It
wouldn't just be the Guard forces with their, you know, with
their guns and with their ability to protect property and so
forth. We would need all of the medical expertise that we can
possible muster.
And the public health system and the Public Health Service
would have to be at the heart of that. I believe you said in
the beginning, Mr. Chairman, and I want to strongly underscore
your point, because I believe that we really need to pay a lot
more attention to our public health system. That is the case
even if we don't have a terrorist outbreak. That is the case
with just natural infectious disease.
Governor Keating. And as a response to that need for a
coordinated mechanism it was for me, representing the State and
local authorities, to say, don't forget the National Guard best
responds to local oversight and control. Don't forget the
Salvation Army. Don't forget the local health officials. Don't
forget the American Red Cross. Don't forget the churches and
the social services agencies who must be coordinated into this
health care response as well. You can't have any success unless
they are integrated fully in it.
Senator Nunn. But one final possibility, we'll get back to
the scenario, every one of those people you are trying to
mobilize is going to have to be vaccinated. You can't expect
them to go in there and expose themselves and their family to
smallpox or any other deadly disease without vaccinations.
So that is the front line. That is the front line more than
any purely military force. You have got to vaccinate them and
you have got to have that right at the beginning, and that kind
of supply needs to be set aside.
Mr. Hamre. Mr. Chairman, we are now at the end of the 6th
day. And so let me now go to the next chart.
[Video played.]
Mr. Hamre. Next chart, please. This is the beginning now of
the third phase of our exercise. It was on the 12th day of the
scenario. The most important thing is the second bullet.
Remember, this is--smallpox is so dangerous, because it is
communicable. And every one person who gets it probably is
going to infect 10 more.
Now is the first time that we are starting to see the
second wave of infections. That is the infections of people
that came in that caught from people who were exposed in the
very first hour.
As you can see, in the last 48 hours there were 14,000
cases. We now have over 1,000 dead, another 5,000 that we
expected to be dead within weeks. There are 200 people who died
from the vaccination, because there is a small percentage, and
we have administered 12 million doses, but now we have 200 that
died from the vaccine. At this stage the medical system is
overwhelmed completely.
Next chart, please. This was what the members of the
National Security Council saw. They saw this spread. You see
the three red zones. Those are where the initial attack took
place in Oklahoma, in Atlanta and in Pennsylvania. The Oklahoma
attack was successful. But, as you can see, it spreads widely.
Anyway, next chart, please.
These are the cumulative--the results of the cumulative
compounding of the people that have been infected. You see the
cases per day, and you will see it starting to rise at day 18
and starting to go up sharply. That is the second wave of
infections, people that are catching it from the people who
were first infected.
Next chart, please. And this unfortunately was what the
National Security Council was looking at. For people that may
not be able to see that in the back of the room, at the end of
the first generation of infections, this is approximately
December 17th, there were 3,000 infected, and there were 1,000
expected to be dead.
At the end of the second generation, what we were now
looking at, it would be 30,000 infected, and 10,000 dead. We
were forecasting within 2 weeks to 3 weeks that we would have
300,000 who would be infected and 100,000 dead. As you can see,
it goes off the charts.
It was roughly by the fourth generation that we would
expect to be getting vaccine produced in the emergency
production.
Next chart, please.
[Video played.]
Mr. Hamre. It was at this stage that we were confronting
the reality that forcible constraint of citizens' behavior was
probably going to be required to be able to stop that fourth
generation of infections.
Let's go to the next chart, please.
We'll talk very briefly about lessons learned.
Next chart, please. I think we felt that this would cripple
the United States if it were to occur. We have a population
that is no longer inoculated.
For all practical purposes, 80 percent of the population
has been born or is no longer affected by the vaccines when
they stopped back in 1978. So the country is now vulnerable.
Local attack quickly becomes a national crisis, and we saw that
very quickly once it spread.
The government response becomes very problematic when it
comes to civil liberties. How do you protect democracy at the
same time that you are trying to save the Nation?
Next chart, please.
We found that it was very hard--we are not very well
equipped to deal with the consequences. I am going ask Jerry
Hauer to comment on that when we get around to comments later
on. We lack the stockpiles of vaccine. I'll ask Peggy Hamburg
to briefly speak to that, because this is one of the key
things.
We had 12 million doses, but it is clear that 12 million
doses aren't going to be enough if we get into this kind of
crisis. It is very likely that you are going to have to change
peoples' behavior. How? That becomes a key question.
Next chart, please.
We didn't have the strategy at the table on how to deal
with this, because we have never thought our way through it
before, and systematically thinking our way through this kind
of a crisis is now going to become a key imperative.
It clearly is going to require many more exercises. The
government is going to have to--and we are very pleased that
the person who for--Governor Thompson is going to be the
Coordinator for Bioterrorism Response. Scott Littlebridge was
with us at the exercise.
It is now very clear that public health is a national
security imperative. This is not a choice, this is now an
imperative.
Next chart, please.
We found that State and local resources were going to be--
relations, I should say, are going to be hugely strained at
this time. The perception in Washington is so different from
the perception in the field. That is something that I hope that
Governor Keating and Senator Nunn speak to.
When I say government lacks coherent decisionmaking, this
is not a critique of the exercise. I thought it was the finest
national security discussion I had ever seen, and I have been
through about a dozen of them. It was by far and away the best
that I have ever seen. But it still is very hard to cope with
something that you have never experienced before ever, and we
are going to have to start doing exercises. Hopefully that is
as close as we'll ever get to it.
And finally it is going to take an investment. It is going
to take an investment in public health, it is going take an
investment in research and development. We have got to find
some solution to this problem. I think that concludes, Mr.
Chairman.
Let me turn it to my colleagues, I think, because they had
important observations before we wrap up and turn it to you for
questions.
[The prepared statements of Mr. Keating, Hon. Sam Nunn, and
Dr. Hamre follow:]
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Mr. Shays. Do you all--since I have already lost control of
this--do you all have a sense of how you want to proceed?
Mr. Hamre. I think we can just work down the table.
Mr. Shays. Senator Nunn, you look like you're ready.
Governor Keating. He is the President, so outranks a mere
Governor.
Mr. Shays. Mr. President, you have the floor.
Senator Nunn. I lost control of the National Security
Council during this whole exercise, too.
It was two or three real frustrations. One is there was no
intelligence, couldn't find any intelligence. We had no way to
link these attacks with any foreign country. You know, your
urge is to retaliate, but you have no idea who to retaliate
against. That is the point that Governor Keating made.
Second, you really know from the beginning, when you first
hear about smallpox, the credibility of the U.S. Government is
absolutely essential. And yet, when you are faced with your
first news conference and you turn to your colleagues around
the table and give me the information base, give me the basis
on which I am going to speak to the American people, you know
you need to be candid.
You know you need to be as reasonably accurate, you know
you need not to be reversed from what you said in 3 days. You
have no information base, and yet you have got to reassure
people and you have got to calm them down.
That was one of the most frustrating things, and from that
came the acute awareness that dealing with the media in one of
these, if it becomes a reality in one of these real terrorist
attacks or outbreaks of infectious disease which got out of
control, dealing with the U.S. news media would be essential.
They would have to be partners, because if you lost credibility
and they basically started attacking the government you would
have nothing but chaos.
And so you certainly couldn't co-opt the media, and that
means that you have got to have a lot of advanced preparation,
you have got to know what you are talking about. You have got
to have the best spokespeople that you can possibly have at the
Federal, State and local level, and there has to be some
coordination in advance.
I think your most credible people would be your health
officials. And I believe that the more I thought about this
afterwards, the more essential it became, in my own mind, to
have a whole group of health officials at every level who work
together and who could speak to this subject with credibility,
because I think if you tried to get law enforcement people out
there talking about apprehending someone when people are faced
with smallpox right next door, they really would say, that is
not what I am worried about. I am worried about my family and
my children.
So those are a few things. But, we really need to be
prepared. The government is not organized for this. We need to
be structured for it. We need to think about it in advance. We
need to do the best we can in terms of detection. I think we
need a global health system that can detect at an early stage
any infectious disease, because in the period of globalization
when people are moving all over the world, if we don't have
that early warning, whether it is from Africa or Asia, or
whether it is Oklahoma City to the world, then we are not going
to be able to get in front of this kind of episode.
We need a whole lot more vaccine. We need to have an
analysis from our people in the government what the threats
really are and which threats are greatest.
You can't prepare for every threat. But we have to have an
array of threats as to which threat is greatest in terms of
biological, then we have to weigh chemical and we have to weigh
nuclear, we have to weigh missile defense, we have to weigh all
of those threats in an analytical way, and I don't think we
have done that yet.
Because there is going to have to be some real money spent
here if we are going to get a public health system. The market
forces--and this is the other thing that the Governor and I
were talking about earlier. The market forces in this country
for health care are striving for more efficiency. That is what
Congress has really tried to set up, and rightly so. But the
more efficient you get, the less excess capacity you have. And
when you get one of these outbreaks or an infectious disease
outbreak, you have got to have excess capacity, you have got to
have vaccine that may never be used. The marketplace is not
going to provide that.
The marketplace simply can't provide it. You can't ask the
pharmaceutical company to go out and for free develop smallpox
vaccine by the millions of doses when the likelihood of that
happening is certainly not very great.
And yet if you are not prepared, you are in real bad shape.
So it is clearly a governmental area. And I think we need to
use market forces wherever we can. But there are a lot of areas
there that are going to work against efficiency, but toward the
protection of public health. Most of all, I would underscore
preparing and paying real attention to the public health system
of the country.
Mr. Shays. Mr. President, who do you want to recognize
next?
Senator Nunn. Well, during our scenario, the Governor never
needed to be recognized. He really was just very assertive the
whole time, and we really did enjoy having him there. I am not
sure I would advise any President to have a Governor in the
room, because they would find out how ill-prepared we are up
here.
Governor Keating. But I was respectful, Mr. Chairman.
Mr. Shays. I am sure you were.
Governor Keating. I think the natural result of this should
be a debate, a discussion, of how to respond to both man-made
and natural disasters. What are the likely natural or man-made
disasters that you will confront? Those that influence the
middle of the country and are anticipated, tornadoes on the
coast, hurricanes, obviously earthquakes. Every fire
department, police department, civil emergency management
agency worth its salt has murder-boarded the issue of response
to a national calamity that happened and frequently happened on
more than several occasions.
You know, in--when something like that happens, you need so
many hospital beds, you need so much water, you need so much
extra power. You need so much quantity of medical supplies. And
you have murder-boarded, you have debated it. You have
discussed it with your National Guard commander, with the civil
emergency management people. The leader of every State has to
anticipate and respond.
This is the kind of thing that the States, individual
States, are not in a position to anticipate and respond,
because they have no knowledge.
What stunned me, and Dr. Hamburg during the scenario made a
very excellent statement to the effect that medical doctors,
many medical doctors, health care professionals, because
smallpox has been eradicated from the United States and from
the world for several generations, that there is no knowledge,
no experience. So when something like this happens, as Senator
Nunn said, to have health care professionals probably
coordinated at the State Department of Health level, trained at
the State level to recognize plague, to recognize contagious
diseases, and then to be able to access perhaps through FEMA
the body of knowledge necessary to respond quickly. I must
confess that obviously I carried the torch of State and local
responsibility, but I was rather surprised at the level of
ignorance, if not prejudice, toward--against, I should say,
State and local responders.
The truth is the first information that people receive
locally about a contagious event or a terrorist act will be
from the local television, radio, local media. It needs to be
accurate to the extent that the information can be provided,
that it is accurate. The initial responders always will be the
local police, local fire, Red Cross, the social service
agencies below. They need to have accurate information. They
need to be able to access, as--again, as I said, perhaps
through FEMA, I think most respected at the State level to
provide that information, the knowledge base to respond
intelligently and quickly to a calamity to make sure that there
is not a greater swath of tragedy than can be controlled.
For example, in my case I mentioned I closed the airports
and the roads. All of this was spontaneous after I was told as
a Governor this is highly contagious, frequently fatal. Well,
obviously I don't want people coming in and then going out and
affecting other areas if this was an attack on a city in my
State. Was that a right or wrong decision? Well, it was made,
and I could only make it based on the information given to me.
The information given at the scene, because I just happened, as
a friend of President Nunn, to be there, was that quarantined
isolation is essential, especially because there is no
treatment and because death can occur.
Well, the need to be able to have that information fully
available, quickly available, accurately available to be able
to send in the medical personnel, to be able to be assured of
food and water supplies and other health care essentials,
particularly vaccines, these are the kinds of things that we
can't produce locally, we have to access.
Now, I think when we got into the argument over the
nationalization of the Guard, I pointed out if I had to go
through 15 different people to get a decision to be made,
that's not good. On the other hand, if one person, my adjutant,
can make the decision or I can, people that know me, know the
Governor, know the mayor, know the police chief, know the
anchor on television, the local officials with excellent
information from Washington can make wise judgments and
decisions that will be embraced by the generality of the
populace. But this discussion must take place within the
context of State and local first responders. They are the ones,
for better or for ill, that will either do it well or muck it
up, and if the information provided us is inadequate or
inaccurate, then the response may be quite different, and the--
and the concentric circles of tragedy may be much wider if the
information early on is not accurate and fully available to
those of us at the State and local level who must make the
decision to respond.
Mr. Shays. Mr. President, who's next? Who would you like
next? Dr. Hamburg or Dr. Hauer? Mr. Hauer?
Mr. Hauer. Mr. Chairman, thank you. I'll be brief. I want
to emphasize a number of points that this exercise brought out,
and I think you've heard some of them already: One, that the
country is woefully prepared to deal with an incident of
bioterrorism. More importantly, an incident of bioterrorism
with a contagious agent would absolutely devastate this Nation
at this point in time.
Some of the issues we had to deal with and struggle with
throughout this exercise are issues that need attention. I must
say that Secretary Thompson, whom I've been working with for
several months now, has made this a high priority and is a--as
part of the reorganization of the agency in putting Scott
Lilbridge in as special attention--special assistant is--he
wants to ensure that as we move forward, we address some of the
issues that came out of Dark Winter.
I think one of the things that both the Governor and
Senator Nunn emphasized that we had to deal with was this whole
issue of augmenting medical care at the local level, something
that would be an enormous challenge. I think that the approach
that we've taken so far as a Nation is we've looked at various
little stovepipes in getting the country prepared. We've got a
vaccine in place. We've put some teams around the country, the
Metropolitan Medical Strike Teams, but we have not looked at a
comprehensive system. An incident like this is going to take a
number of things coming together, or we are not going to be
able to respond.
Let me give you one example. You keep hearing about
vaccines. We clearly at this point in time don't have enough
vaccines in the United States to deal, one, with an incident.
Having the vaccine is great, but having the ability to
vaccinate people is going to be a challenge in any
jurisdiction, particularly larger cities where you have to
vaccinate millions of people in a very short period of time.
The logistical infrastructure necessary to vaccinate the people
of New York City, Los Angeles, Chicago is just--would be mind-
boggling. At the same time you're dealing with the logistical
infrastructure necessary to deal with vaccination, you've also
got to augment the local medical care because, as Senator Nunn
said, we're in an environment where hospitals are scaling down.
We don't have residual medical capacity. I don't know where at
this point in time we would get that augmentation of medical
care. We would have to rely on the DOD, we would have to rely
on the National Disaster Medical System, but if, in fact, you
had more than one State, more than one city, multiple large
cities, we would rapidly exhaust that capacity very quickly.
Then, I think there's a couple of other important points,
and then I'll let Dr. Hamburg make her comments. We need to
address some of the issues of isolation and quarantine and the
legal authorities necessary. We struggled with that throughout
the exercise. Who has the authority to do what? How do we
enforce it? At what point in time do we use force on the
citizens of this country? And who makes that decision?
And then finally I think it's very important that we look
at the psychological impact of one of these incidents and how
psychologically it will impact both the people that are
involved and the responders, something that I don't think we've
planned for. I know that there is some work going on right now,
but the psychological impact of one of these incidents would be
absolutely devastating both on the people that are impacted by
the incident and those people that have to respond just by the
sheer nature of the stress of one of these incidents.
I think back when I was a director of emergency management
for New York City, my worst nightmare was one case of smallpox,
not dozens, but if I had gotten a call saying that we had one
case of smallpox, that would be a major, major public health
incident in the city of New York, and at this point in time, as
well prepared as I think we were in New York City, no city, no
State is capable of dealing with an incident like this.
One final point. Smallpox is somewhat unique because unlike
anthrax where you have to disseminate the agent here in the
country, where you have to go into the subways, you have to go
into an environment like a building like this and spread it,
they could actually infect these people just--you know, we have
people who are suicide bombers who want to die for the cause,
and with smallpox you can infect these people overseas, send
them into the country. They never have to be carrying the agent
with them, so there's nothing to search, and as they become
infected somewhere between the 9th to 12th day after they've
been exposed, they then start riding the subways, come into
buildings like this. They might have pox on them, but in the
early stages it would probably not raise a lot of concern, and
they could actually be the carriers, the Typhoid Mary's, so
that speak, and spread this thing throughout the country, and
we'd never know what hit us.
Thank you, Mr. Chairman.
[The prepared statement of Mr. Hauer follows:]
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Mr. Shays. Dr. Hamburg.
Dr. Hamburg. Thank you. I'll try to be brief so we can get
to your questions.
I should say at the outset that I came to this exercise and
come to the discussion today with both a local and Federal
perspective. I served 6 years as New York City's Health
Commissioner, was Health Commissioner during the bombing of the
World Trade Center, and also in that capacity clearly managed a
wide range of infectious disease and epidemics, and also began
a program to deal with the threat of bioterrorism. I then spent
close to 4 years at HHS helping to shape a still fledgling
bioterrorism initiative there. So for me, addressing these
kinds of issues could not be of greater importance, and the
importance of the partnership and planning that has to occur
today in order to address the different levels of government
and the cross-cutting nature of the response required is
absolutely essential.
I think that the most important point, and why in some ways
this exercise, I think, was somewhat unique, was that it really
demonstrated how a bioterrorist event would be different from
the other kinds of conventional terrorist attacks that we are
more familiar with, sadly; or even an event using another
weapon of mass destruction, that it would really unfold much
more slowly over time as a disease epidemic; and that the
traditional first responders from a lights-and-sirens kind of
response would be police and fire, but would be Public Health
in the medical care system, and that we really need to make
sure that we invest adequately in a robust public health system
and support our medical care system so that we can provide the
response that will be needed to contain and control an event
like this.
That means that we need to really invest in our public
health system. We need to improve our disease surveillance
systems, our outbreak investigation capacity so that we can
rapidly detect an event if it occurs, because rapid
mobilization of response is what's going to be key to saving
lives and containing the disease. We have to make sure that we
have a medical care capacity, as others have said, that has
enough flexibility in it that we can respond. This will be key
for both naturally occurring and intentionally caused events.
We do need to develop new drugs, vaccines, and diagnostics to
make our Nation better prepared. We need to invest in research
so that not only are we developing the drugs and vaccines that
we know today might be effective against agents used in a
potential bioterrorist event, but we have to think about new
ways and new approaches that might give us greater capacity in
the years to come.
For example, not just thinking about one drug, one disease,
but thinking about the possibility that in the future we might
see genetically engineered threats or agents that we hadn't
previously dealt with, or even as we speak today there are many
diseases that exist in the world, many microbial agents that
threaten the human population for which we have no drugs or
vaccines. So we need to really develop an appropriate research
agenda and invest in that.
And I think critically Dark Winter underscored for all of
us the importance of planning, preparing, and exercising. We
have a very complicated challenge before us that will require
many different agencies and levels of government to come
together. We cannot afford to be learning things for the first
time in the midst of a crisis. We must think about the types of
challenges before us, and we must think about the kinds of
strategies that would be effective in addressing them and put
in place the necessary systems.
And as I think, as others have mentioned, the good news
here is that many of those investments will have immediate
payoffs in our ability as a Nation to deal with naturally
occurring infectious disease threats. So we appreciate what
you're doing to help make our Nation stronger against the
threat of infectious disease.
[The prepared statement of Dr. Hamburg follows:]
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Mr. Shays. Before I recognize Mr. Gilman for the first
questions, I just want to make a few observations as chairman.
One is I found myself getting very uptight. I thought, what are
you, nervous? I found myself feeling very uneasy, and then
thinking you can't laugh when you're talking about something so
serious because, you know, that's kind of absurd.
And I was thinking that you--the two unrealistic things for
me, the only two that I really heard, is, one, that you would
have been in Washington, and, two, that you would have stayed
in Washington because, knowing you, you would have gone back
home with your constituents and your family.
But then I found myself saying now, do you get the vaccine?
And then if you get the vaccine, are you going to get the
vaccine and not allow your wife to or any other family member?
And then if you get the vaccine, and then you order people that
they have to stay in Oklahoma, the outcry is, yeah, it's easy
for you to do, you know, and just the implications in the talk
shows and the--it was a chilling, chilling thing to see this
news broadcast and knowing that was less stated than CNN. I
mean, I can imagine what some would have said and how it would
have been said.
So I just find myself in one sense grateful as hell,
frankly, that you all have been able to dramatize this, because
there have been a number of people who have been trying to say
to people in the United States and to our government, wake up,
and not to steal something from Mr. Tierney, but to give him
credit for this question, he said, which is more likely, an
errant missile from North Korea or this kind of experience, a
terrorist attack? Not that they are mutually exclusive, but if
you told me I only had the dollars for one, there's no question
that I would put my dollars here.
Then just two other points. Senator Nunn, your comment
about the World Health Organization, I chaired the Human
Resource Subcommittee of Government Reform. We oversaw HHS,
FDA, CDC, VA, a whole host of others related to health care,
and I am in awe of the World Health Organization. I mean, the
attack I fear most is the pathogen. It's not the soldier with
the weapon. And some of these individuals in the World Health
Organization go around the world unarmed trying to determine
what is this outbreak.
And I conclude by just saying to you I have so many
questions. I mean, I couldn't keep up with the questions that
you all generated by your presentations. So I know you--like
you wanted to just make a point since I mentioned your comment
to me, but I would----
Mr. Tierney. No. I'll wait.
Mr. Shays. OK. You'll have plenty of time.
Mr. Gilman, you have the floor.
Mr. Gilman. Thank you very much, Mr. Chairman.
It's certainly startling to hear all of these observations
by this panel. Let me ask--I think it's Mr. Hamre--you've been
the sort of the guide to putting it together; am I right?
Mr. Hamre. Sir, I was--I head up one of the three
organizations that cosponsored it. We did coordinate it at
CSIS. Sue Reingold behind me was the coordinator. Randy Larson
was for Answer Corp., Tom Inglesby for the Johns Hopkins
Center, and he's----
Mr. Gilman. Was it Mr. Larson's idea, this initial thinking
about all of this?
Mr. Hamre. Well, I think Colonel Larson and Sue Reingold
first started together, but the three were the teammates, and
Tara O'Toole, who's not with us today----
Mr. Gilman. Did any government agency participate, any of
our Federal agencies participate in your Dark Winter?
Mr. Hamre. We had observers that were at the exercise from
the Federal Government, from the various offices that I said.
Scott Lilbridge, who is going to the coordinator for Governor
Thompson, Secretary Thompson, he was there; very important that
he could participate. We had, I think, six committees,
congressional committees, had representatives there.
Mr. Gilman. Six of our committees? Which ones?
Mr. Hamre. Your committee was there, and we had
representatives from two committees in the Senate, and then we
had individual offices.
Mr. Gilman. When did you conduct your seminar?
Mr. Hamre. We did it on June 22nd and 23rd, sir.
Mr. Gilman. In 2 days?
Mr. Hamre. Yes, sir. It was on Friday and----
Mr. Gilman. I want to commend you all as panelists. You
certainly put together some information that we ought to make
good use of. Now, what are you going to do? You've got lessons
learned, and I see you have about nine recommendations. No, I'm
sorry, you've got 12, 12 significant recommendations. What are
you going to do with all of these?
Mr. Hamre. We ran out of computer disks or we would have
probably had about 40. But, sir, we're in the process right now
of producing a report that's part of the grant that we were
given the McCormick Tribune Foundation and by the Memorial
Institute for the Prevention of Terrorism----
Mr. Gilman. And what are you going to do with that report?
Mr. Hamre. That is going to be circulated and made
available to the Congress and the executive branch. It really
highlights the things that have to be done. We've signaled some
of them here. The most important is that the government needs
to start exercising itself, it needs to start going through
this process to find out what we would do when we're confronted
with that sort of a dilemma.
Mr. Gilman. Where would you focus that attention? Who
should be the implementer now of all of this? Should there be a
central office, for example, to implement your recommendations?
Mr. Hamre. Sir, I think that President Bush has decided
that he's going to put the focal point with FEMA, and the
Director of FEMA is going to be taking the lead. The Vice
President's office is coordinating an interagency review
process right now.
Mr. Gilman. Of this report?
Mr. Hamre. No, sir, of the issues in general, and we'll be
sharing it with FEMA's Director, Mr. Lacy Suiter. We'll be
getting together with him later this week, and I'm meeting
tomorrow with the Vice President's Chief of Staff.
Mr. Gilman. Now, what would your panel feel is the
appropriate central authority for instituting your
comprehensive plan?
Mr. Hamre. Well, I will let others speak, but, sir, I think
that it has to be--President Bush needs to decide how he wants
to organize his government. I think he's decided that. I think
he wants to put the focal point on FEMA and then have the Vice
President be the coordinator of the interagency review that's
required to support that. So I feel that decision's been made.
I think we ought to be doing what we can to help him make that
decision work.
Mr. Gilman. Let me ask our other panelists, what do you
recommend for proper and effective implementation of your
findings?
Governor Keating.
Governor Keating. Well, let me analogize, if I may, Mr.
Gilman, to the Oklahoma City bombing. We had a criminal
investigation going on simultaneously with a rescue and
recovery operation. It would be a similar event if this were to
occur, a criminal investigation in companionship with a rescue
and recovery and health care response. Obviously local police
and the FBI would be in charge of the criminal investigation,
but they are not health care providers. And the rescue and
recovery people, the local civil emergency management people
are not criminal investigators.
The resources that are needed for the purpose of responding
to the health care challenge, not the criminal investigation--
those resources are already fully available in the FBI--have to
be directed through an entity that the State and local
governments trust and frequently work with. In my judgment,
that is FEMA. During the tornadoes that we had 2 years ago, the
most severe ever to strike the United States, and, of course,
the Oklahoma City tragedy of April 19, 1995, under then
Director James Lee Witt, the sources that were provided were
provided promptly and fully, the advice and counsel promptly
and fully in companionship with State and local authorities.
It's a mistake to have someone say, I'm in charge here.
There has to be a sense of comity and goodwill and joint
sharing of responsibility, and that can be, is done, all over
America all the time. In this kind of situation, you need the
medical and the health care fast, and, in my judgment, only
FEMA should be able to provide because we work with FEMA
always.
Mr. Gilman. You think FEMA, then, is the appropriate
agency----
Governor Keating. In my judgment, yes, Mr. Gilman.
Mr. Gilman. Senator Nunn.
Senator Nunn. I think the Governor's last point is what I'd
like to underscore. This cuts across agency lines. I've heard
John Hamre say a number of times that government's involved and
structured as stovepipes, and yet vertically, but the problem
here is horizontal. So it goes across a lot of different
agencies.
I commend Secretary Thompson for stepping out and having
real emphasis on this, as we heard from Jerry Hauer. I also
believe that someone from the National Security Council is
going to have to have this portfolio, and I would have someone
have this portfolio who's not spread too thin so that they can
look across governmental agencies. I think the State and
Federal has got to be given a lot of attention from the
National Security Council and the HHS point of view. I believe
it's essential that HHS officials be able to coordinate and
have the President's blessing in advance clearly made--made
clear to the other Cabinet officials, with Department of
Defense, with the CIA.
I've been told that there are some HHS officials in key
spots that deal with this overall subject that don't have
clearances. We are going to have to have coordination between
health and security. I believe that is one of the fundamental
underlying principles here is health is security, and an attack
on the public health in this country is a security threat, and
we have to join those. So I think that's the way I would
approach it.
I also believe----
Mr. Gilman. Well, Senator, if I might interrupt then, are
you disagreeing that FEMA should have the ultimate authority?
Senator Nunn. I think FEMA is going to have to play a big
role, but FEMA does not have the health kind of capability that
they are going to need. They're going to have to go into the
local communities and deal with doctors, and they're going to
have to do it up here in Washington.
Mr. Gilman. What I'm seeking is who should be the--have the
primary authority here?
Governor Keating. Mr. Gilman, let me postscript what I
said, and I'm afraid I didn't fully develop my thought. What
happens here is very relevant to what happens in Philadelphia
or Atlanta or Oklahoma City. The coordinating mechanism here,
for example, as Senator Nunn has indicated, if--within the
National Security Council there's a portfolio for this. If
there is a coordinative group put together in Washington under
the Vice President's direction or under the FEMA Director's
direction, it doesn't matter as long as HHS, everybody's around
the table, Department of Defense, developing the book, how do
you respond to this, smallpox or a hurricane or tornado? Then
you take the book and give it to FEMA to share it with State
and local officials who'll have to implement the results of the
book.
What I'm saying is to have a whole panoply of Federal
agencies descending on a city won't work because the local
health commissioner, the local mayor, the local police chief,
the local National Guard commander, those are the ones that
will actually implement the book, the reaction to whatever this
tragedy may be.
Mr. Gilman. Governor----
Governor Keating. How it's coordinated here is not as
important as having some kind of product that is shared with
FEMA that we deal with daily in response to man-made and
natural calamities.
Mr. Gilman. Governor, that's why we recommend a specific
agency or a specific comprehensive coordinator. We just went
through a hearing on fragmentation by so many agencies on
proper supplies for our defense forces--we found was fragmented
through a number of agencies, and there was really no central
controller, and that's why I'm seeking----
Senator Nunn. Well, the key here is it's got to come under
the President. He's got to direct it because unless his
authority's behind it, my experience is you can pass a piece of
legislation and say somebody's czar of something, and yet if
the czar doesn't have any troops out, and if he doesn't have an
agency, and if he doesn't have a large budget, and if he
doesn't have power in the bureaucracy, nothing happens.
I remember when we appointed a drug czar, Mr. Chairman,
many years ago.
Mr. Gilman. We worked together on that.
Senator Nunn. Yeah, we did, and I supported that. But after
he'd been in office about a year, year and a half, he came to
see me, and I was shocked to find what he wanted me to do was
get him an appointment with people at the Department of
Defense. He hadn't been able to get an appointment at that
stage. Now, we had the drug czar up here, but he didn't have
anybody under him. He didn't have any power----
Mr. Gilman. We finally got him into the Cabinet.
I have a moment or two left. Dr. Hamburg.
Dr. Hamburg. I think it is key that we have a national plan
and one that involves a true cross-cutting approach. Preferably
I think, and it's my personal opinion, there needs to be some
mechanism of coordination that's central that has real
accountability for both programs and to some degree budgets so
that we really know across this wide array of agencies----
Mr. Gilman. I think we recognize that. What I'm looking for
is do you--have do you folks have some specific recommendation
of who could do that most effectively?
Dr. Hamburg. Your question in a way was who on the ground
should be the lead also, though; right?
Mr. Gilman. Who nationally should take control of all of
this?
Dr. Hamburg. You know, I think it actually could be a
number of different players, but the key is that it be clearly
defined and that we build around that. I think, as Dr. Hamre
said, the President has made the decision that it should be
FEMA, and I think operating on that assumption, that there are
very natural partnerships that can then unfold. We want to
build systems to respond to this threat that complement the
kinds of activities that we do every day either in public
health, disease control, or in emergency response so that we
are not creating----
Mr. Gilman. I'm exceeding my time, and the chairman is
getting a little antsy on his gavel. Mr. Hauer, could you just
answer----
Mr. Hauer. Yeah. Very simply, FEMA needs to be the
overarching agency that does the coordination of this at the
Federal level and then rely on agencies like HHS for the
expertise to deal with the unique parts of the bioterrorists--
--
Mr. Gilman. Thank you very much. Thank you, Mr. Chairman.
Mr. Shays. I thank the gentleman.
Just another observation. I felt like I've been in the
middle of a movie, and maybe that's why I was anxious. I wanted
to know how it turned out. And so I asked my staff how did we
finally get a handle on it, you know, 12 million vaccines out,
the disease spreading? And the response was we did not get a
handle on it. They stopped the exercise before resolution. Kind
of scary, huh?
Senator Nunn. One thing, we were faced with a dilemma of
having received very graciously from Russia a very large supply
of vaccines, and we were then trying to decide whether to use
them, and, of course, one of my national security people popped
up and said, what if it's sabotage? Can we test them? And we
were still waiting on the other emergency vaccines to come in,
and we were in panic, as you saw on television. So we can't
contend that we solved this problem, but I do think that no
policy person, Congress or the White House, could sit through
this and not say, we'd better get off the dime, we'd better do
something about it.
There's one other thought I'd like to inject that I don't
think has been covered. We basically need to have the people
who deal with biology understand the sensitivity of the
materials they are dealing with if they got in the wrong hands.
There needs to be an ethical best practices safeguarding system
in this country to begin with, but throughout the world, in
dealing with these materials, most of which are local, legal
and legitimate. It's not like nuclear materials, which they are
hopefully safeguarded except in certain spots, and we're trying
to work on that in the Soviet Union, but the biological
materials are part of our everyday commerce.
Mr. Shays. Thank you.
Mr. Tierney, you have the chair as long as you want it,
give or take.
Mr. Tierney. Thank you.
Thank you all for your testimony and for going through that
exercise. I didn't make an opening statement, so I'm going to
take the liberty of just making at least an opening comment
here.
Senator, you talked very briefly about prioritizing the
threats on this country, and I couldn't agree with you more.
I'd be remiss for my own personal reasons in not just saying
here that I think it's abominable that we are spending so much
time on reinventing Star Wars and all this other silliness
that's going on here without attending to a real prioritization
of what real threats are and making a determination as to what
really needs our attention first and how deeply that attention
is needed.
I note also that this administration just pulled out of the
protocol for the biological weapons convention, so at least in
the short term we won't be getting any real notice for any
situation like this, nor the opportunity to inspect or to move
in that direction, both of which I find a little disturbing.
Let me ask, I would assume, Mr. Hauer, that we don't have
the hospital capacity right now if we were to get involved in
an incident like this with all the hospitals downsizing. I
would assume that if we're really going to be ready for this
type of an incident, we would try to think of some system,
statewide at least, Governor, if not nationally, to determine
how many hospitals we ought to have, where they ought to be
placed with ready access to people.
Mr. Hauer. You're absolutely right. I think, though, it's
unrealistic to think that hospitals are going to develop a
surplus capacity and just have it on standby for an incident
like this just because of the cost. I think the issue at this
point in time is trying to figure out how, when we have an
incident like this, whether it's anthrax, smallpox, or some
other agent, we can rapidly increase capacity both in existing
facilities by augmenting staff and then finding alternate care
facilities or casualty collection points where we can triage
people who are sick with either smallpox or anthrax or
something along those lines, and we take them and put them in a
facility, and we augment the local medical care either with
State resources, or more than likely, particularly with the
contagious agent like smallpox, we'll have to augment them with
Federal medical assets.
Mr. Tierney. Thank you. For anybody who wants to answer
this question, I assume that there was some determination made
or at least some thought given to the fact whether or not we
would want to have enough vaccine for forseeable types of
incidents for our population, or was it that we were thinking
of having an infrastructure in place that could readily produce
the kinds of vaccines and antibiotics that we would need?
Dr. Hamburg. Well, with respect to the smallpox situation,
there was a remaining stockpile from the days when we actually
were addressing smallpox as a disease, and the smallpox vaccine
luckily is fairly durable. There was a decision made a few
years ago that we needed more smallpox vaccine as a Nation to
protect against this potential threat. Obviously it remains a
low-probability threat, but a very high consequence as Dark
Winter, I think, so compellingly illustrated. And so the
Department of Health and Human Services does now have a
contract with a private manufacturer to produce 40 million new
doses of smallpox vaccine.
That is a research and development task, though, and the
current plan, which is somewhat accelerated compared to some
vaccine development, is that those doses would be available in
2005. In the exercise we simulated the possibility that we
might try to mobilize those more quickly. At a stage that we're
at now, one could produce millions of vaccine doses
potentially, but it would be untested vaccine, which, of
course, raises a whole set of other issues in terms of what
does it mean to in an emergency use drugs or vaccines that
haven't yet been licensed? And we made the decision early on
that given the gravity of the situation, we would certainly
move forward.
But smallpox vaccine is one critical need that I think as a
Nation we need to continue to address, make sure that we do
develop that additional vaccine supply, and I think that we
need to make sure that we think about the investment in
developing new smallpox vaccine and other vaccines against the
bioterrorist threat as a security concern, and make sure that
we're not taking dollars from other existing medical problems
to support that vaccine development, but that we see it as part
of our national security investment.
Mr. Tierney. Just for the additional doses of this smallpox
vaccine you're talking about, it's about $350 million, and that
is for smallpox, but I guess I'd like to also ask you do we
look at the other anticipated things that might happen, anthrax
or whatever, and also decide what a fair amount is to set aside
on those?
Dr. Hamburg. Absolutely. I think we need to really step
back, and I wanted to make the comment earlier, in addition to
thinking about what do we need to do in order to improve on the
ground response, we also need to ask the bigger question about
what do we need to prepare, overall preparedness. And part of
that is really defining the set of threats as we see them today
in looking at what do we have to respond to them and making
sure that we develop new drugs, vaccines, and diagnostics for
rapid detection to address those, and that we also think into
the future about what we may need, given what we know about the
new understandings of biotechnology capacity, the revolution in
genomics, etc. We can't just assume that the diseases we know
today are the threats of the future.
So I think we really do need to think very carefully about
developing a research and development agenda, and there is no
doubt, as Senator Nunn indicated earlier, that we cannot rely
on the marketplace to serve our country's needs in terms of
some of the new pharmaceutical tools that we really will
require to be truly prepared.
Mr. Tierney. But the shelf life--I guess the shelf life of
these things, if you make that vaccine, how long is it going to
be good for?
Dr. Hamburg. It depends on the particular vaccine. The
smallpox vaccine stockpile that we have today is really very
old. In the best of all possible worlds, I think we wouldn't
choose to keep that vaccine on the shelf that long, but it's
tested periodically, and it has been determined and FDA
approved as good to go in a crisis.
But, you know, depending on the drug or the vaccine, there
are shelf lives that come into being. When there's a drug or
vaccine that's used routinely in medical care, you can create a
stockpile mechanism that allows you to recycle those drugs or
vaccines so that you don't have to just put them in a warehouse
and throw them away, but that you could have the capacity to
surge if you needed it in a crisis, but use those in routine
care. Something like smallpox, we don't use it routinely, so it
will be stockpiled in the traditional sense of the word.
Mr. Hauer. I want to allude to a point you had made, and I
think it's one of the disconnects that we've got at the Federal
level. As you look at vaccine development, trying to look at
research and development activities on new vaccines, you have
to really look at the intelligence that we're getting and try
and figure out what the intelligence is and where you've got to
put your money. And there is a disconnect between the
Intelligence Community and the community in Health and Human
Services in trying to understand what the real threats are.
Mr. Tierney. I suppose some of that comes from the CDC and
the sort of assessments of what's going on in other countries
and what's showing up, but I--it also brings me back to the
biological weapons convention. It's important that we get some
sort of a protocol on this if we're going to have any type of
advanced notice or any--the Center's going to just keep making
these things forever. The idea is to try to get some negotiated
concept of how we're going to stall the development, or to the
extent we can't do that, at least try to put something in place
that gives us some ability to have some notice, if I'm not
mistaken on that.
Mr. Hauer. That's correct.
Mr. Tierney. Governor, I would assume that you're--it
sounds like you're very familiar with all the local things of
training and equipment, coordination, communication, structure,
everything that would be needed. It would be expected
reasonably that the Federal Government would pick up some of
the resources for that--local communities, I would guess;
right?
Governor Keating. Well, yes, Congressman. And let me
postscript what Dr. Hamburg said because--and Mr. Hauer said
because it's very important that you vacuum intelligence
sources to determine what is out there and what's needed to
respond to whatever the calamity--anticipated calamity might
be. We do that all the time at the State and local level for
man-made disasters, and everyone, as I noted, prepares for
these disasters, and we know pretty well the kind of things we
need in order to respond.
This is a situation where we don't know because we've never
seen anything like this. Remember, FEMA is State and local--
FEMA consists of State and local firefighters, rescue workers
and the like. The FEMA people that came to Oklahoma City, for
example, came from Fairfax County, VA; from Prince George's
County, MD; from Sacramento and from Los Angeles; and from
Puget Sound; and from Miami-Dade and the like, Phoenix. All of
them are local people who have been thoroughly trained to
respond to, for example, building collapses in this particular
case.
That's all we're saying is that once the Federal Government
figures out what's the problem, then the book that results from
that analysis of what is the problem is distributed to the
local and--the people at the local level, the State level in
every State, an individual and an entity that's responsible for
disaster preparedness and response, and we implement the book.
Mr. Tierney. To the extent that the book may require that
you have certain equipment in local police or fire departments
or other agencies, that you have certain training exercises
that go on, certain ability to have people that can communicate
and coordinate those activities or whatever, is it your
understanding that the local communities would be able to
absorb those costs?
Governor Keating. No, not necessarily. Some yes and some
no, and some, for example, already anticipating certain types
of natural disasters, have equipment and assets in place. But
it depends on the nature of the beast. If there's a huge run on
hospitals, there aren't sufficient resources to build new
hospitals, and you wouldn't anyway. You'd use college
dormitories, for example, remote college campuses, as we did in
the scenario here. But you have to know what it is that you're
dealing with, and then you determine whether or not you have
the assets in place or if you need to import the assets.
Obviously it's a lot cheaper to distribute the assets on a need
basis as opposed to having them in a warehouse someplace, but
it depends on the nature of the beast, the nature of the
extent, how large and how expensive the response would be.
Mr. Tierney. Senator Nunn, let me just close--I think
you're an individual known for having probably spent a great
deal of time thinking about and weighing threats to this
country in an analytical way. On a scale of 1 to 10, with 1
being a very likely scenario and 10 being least likely, what
would be--assess this type of a threat to this Nation.
Senator Nunn. It's really hard to assess the smallpox part
of it as to whether it's smallpox----
Mr. Tierney. As to----
Senator Nunn. But some type of biological attack against
the United States, I'd say the probability of it happening in
the next few years is very high. I think that's probably a
greater threat than the nuclear, although we've got to be very
zealous in trying to safeguard nuclear materials in the former
Soviet Union. As you know, I spent a lot of time on that, and I
think that is a real danger, but I also believe the
dissemination of biological would be something a terrorist
group could carry out much easier than nuclear, in my opinion.
It wouldn't be easy. It's not as easy as some might say, but
it's doable, and I think the nuclear part would be much greater
because the nuclear material would be harder to get access to.
So I always have feared attack by a group that doesn't have
a return address more than I have a country. That way we would
know, for instance, if a missile were launched, and we would
know where it came from, and they would in effect be committing
suicide as a nation. So I fear this kind of scenario. I would
not exclude chemical also as more likely.
I might just add as one footnote, I've now spent a third to
a half of my time on an organization called NTI, Nuclear Threat
Initiative, but we're including the biological and the
chemical. We're fortunate to have Dr. Hamburg, who's heading up
the biological, and we're going to be determining what a
private foundation can do in this area. Ted Turner is funding
it. We don't have unlimited funds. The Federal Government is
going to have to do most of the heavy lifting, but we're
looking at this early warning surveillance system, whether we
can help the World Health Organization and others beef up that.
We're looking at the question of best practices,
safeguarding materials, whether we can inspire the scientific
community in this country and around the globe to organize
themselves as the nuclear industry has done.
The electric utility industry, after Chernobyl and after
Three Mile Island, organized, and they have their own peer
reviews. They have their own safety mechanisms not funded by
the government.
I think the pharmaceutical companies of this country and
the world have a real opportunity here to step up to the plate
and help safeguard a lot of this with their own resources. So
the scientific community is going to have to be much more
aware.
And finally, we're looking at the possibility of really
trying to help get jobs, meaningful jobs, for the former Soviet
Union scientists that know how to make these biological weapons
and spent a whole lifetime doing so, but don't know how they're
going to feed their families. That is one of the most crucial
other aspects of proliferation in the biological arena, in my
view. So we're going to be active in this area, but we know
that the big picture has to be dealt with by the governments of
the world.
Mr. Hamre. Mr. Tierney, may I just say----
Mr. Tierney. Sure.
Mr. Hamre. We had a biological terrorist incident in this
country. People forgot about it. It was 10 years ago. There was
a kooky little outfit out in the Pacific Northwest that sprayed
salmonella on a salad bar and infected, you know, hundreds of
people. We've had it in this country. Now, fortunately, it was,
I guess you'd say, more on a scale of a nuisance, but, you
know, there are enough nuts out there that would want to make a
point, and this is not in the realm of the theoretical. This
is----
Senator Nunn. The Aum Shinrikyo, I had a set of hearings in
1995 where I sent investigators to Japan and looked at the
whole Aum Shinrikyo attack over there, which was chemical, but
they were working on biological, and this was a group that had
hundreds of millions of assets. They had tried to develop
biological weapons. They developed chemical weapons. They'd had
other attacks, and they were even doing some experimentation in
Australia on sheep with biological and chemical weapons, and
all of that was going on with substantial assets in Russia, and
they never had appeared on the radar screen of either our
intelligence or our law enforcement agencies. We never heard of
them until this attack. So it shows the need for coordination,
too, with other nations in the world.
Mr. Hauer. Yeah. The Aum on eight different occasions tried
to use biological weapons and did not overcome some of the
technical problems encountered with these types of agents. But
as the Senator said, this was very high on the radar screen.
They tried using it. They tried killing a judge with anthrax in
Japan and were not able to use the agent successfully, but it's
only a matter of time between--before some of the technical
issues are overcome by some group somewhere.
Mr. Tierney. Well, I thank all of you for the work you've
done on this, and, Senator Nunn, you in particular for the work
you've done in the nuclear area in the past also.
Senator Nunn. Thank you very much.
Mr. Shays. Senator, I notice you're looking at the clock.
It's getting a little late, I realize----
Senator Nunn. I'm thinking of you because you've got
another panel. I've been in your spot.
Mr. Shays. I'll tell you, this is so fascinating that
sometimes you get antsy to ask the questions. I wanted to hear
you all share what you know before we even got to the
questions. I'm going to kind of jump around the board here.
I'm interested, Mr. President, when you had the thought
that Iran might have been responsible, did the military step in
and advocate a response, and then did they get in any question
about the soldiers being vaccinated and taking up some of those
valuable----
Senator Nunn. Good questions, Mr. Chairman. Two points. One
is right at the very beginning of this scenario, the Secretary
of Defense demanded we set aside something like 3 million doses
of vaccine for the U.S. military. Of course, my first instinct
is to protect the military, but after 10 seconds reflection,
the local health officials in Oklahoma City and Georgia and
Pennsylvania were the ones we had to take care of first and
foremost.
The scenario that we had in terms of foreign was the Iraqi
mobilization of tanks toward the Kuwaiti border, and the news
media speculation on Iraq being involved in this was not backed
up by anybody that had any intelligence. We got no
intelligence. I told my good friend Jim Woolsey, who was then
the Director of CIA, that he gave me one hell of a lot of
policy advice sitting around the table and not one ounce of
intelligence.
Mr. Shays. You know, knowing him as little as I do, I have
a feeling he didn't react kindly to that comment.
This is the 20th hearing we've had on this issue, or
briefing, and I keep learning more things. Now, obviously we've
had 40 government agencies on the Federal level. We have 3,000
plus State, county, local governments, and they have all their
departments and agencies. So we're talking about a lot of
people. I'm fascinated by this concept of ultimately, you know,
we don't write a playbook, so we don't know exactly what a
President is going to do and what authority he's going to take
and what authority the Governor is going to take. But it just
strikes me that what ultimately will happen is that the
President will decide whatever the heck he or she wants, and
that's what a Governor is going to do. I mean, you're not going
to--you're not going to question your counsel to say, you know,
do you have the authority?
Maybe, Governor Keating, you could tell me how you would
respond. Let me say you might question them, you just might not
listen to them.
Governor Keating. Of course. Mr. Chairman, I think everyone
in a public position will try to do the best job he or she can
with the information at his or her disposal, and that is the
problem. In this case there simply wasn't the information--the
level of ignorance at least at the local level was very high,
and the willingness to respond intelligently and forthrightly
and quickly was limited by the intelligence, the knowledge at
hand.
So what I'm saying is that the President with the
Governors, there is a relationship, I think, generally of
comity and goodwill. If something like this were to happen in a
multi-State environment, the President will look to the
Governors to provide the execution, and the Governors will look
to the mayors and community leaders to provide for the
execution of whatever the plan is to respond, and that plan has
to be federally developed. There's simply no way that the
Governor of Florida, the Governor of Oregon, the Governor of
New York, whatever, would anticipate nor prepare for, either
with assets or with intelligence, a response to a smallpox or
an anthrax attack.
But what struck me, and I made this comment at our session,
was if you're preparing for war, you anticipate types of wounds
that your troops will receive, and puncture wounds are what
bullets create. So your people are trained, medical people, to
respond to puncture wounds. If this kind of scenario is what
the Government of the United States feels could happen to our
people, then to have doctors at the local level have no
knowledge of it, no knowledge of how to respond to a puncture
wound is potentially grossly negligent.
Mr. Shays. Could you just touch as briefly as you can on
this issue: Did the power vacuum get filled by a President and
Governor who just said, I've got to run with this? Do you think
it's possible to try to anticipate the powers that would be
needed, or do we just kind of let it unfold with people
logically responding to a President, logically responding to a
Governor?
Governor Keating. Well, there's a combination of both
really.
Mr. Shays. And then I'd like Senator Nunn----
Governor Keating. I mean, there's a combination of both. I
think in the case of most States, our civil emergency
management people train for scenarios that they anticipate will
happen to their State, whether it's a hurricane or a string of
traffic fatalities, the shutdown of a subway by----
Mr. Shays. I hear that part.
Governor Keating. So I'm saying, so they're training, and
if an event occurs, the media, everybody comes to us for a
response, and in the case, for example, of the Oklahoma City
bombing, President Clinton called me. We talked about what I
needed, what he was willing to provide. Everything worked like
clockwork because we had highly professional people on the
ground. But if he had no idea what to do because he had no idea
what happened, if I didn't know what to do because all of a
sudden people were falling over dying and we don't have a clue
as to what is causing this, we have a problem. It's
intelligence information that's most in need.
Mr. Shays. Right. I don't mean to be disrespectful. I'm
still pursuing this one question. It seems to me, Senator Nunn,
that in the course of your exercise of responsibility as
President, that you basically decided to make some decisions
without necessarily knowing whether you had the authority or
not, because you knew somebody had to make them.
Senator Nunn. You have to make them, and you have to just
step up to the plate and take the best swing you can, because
at that State you don't have time for a legal research job. You
have to swing, and you have to have a partnership with the
State and local, and I think that's going to depend in the
future about whether FEMA can take this ball and really roll
with it.
I think FEMA has dramatically improved during the last few
years, but they are going to basically have a lot of support
from the White House because they're going to have to cut
across agencies, and they're going to have to do a lot of
groundwork with our counterparts at the State level. If I'm
dealing with Governor Keating in this crisis, and he's back
home and not in the National Security Council, which would be
probably a more natural event, then the question of how well
FEMA's prepared with his people in advance for this or other
type scenarios would be important in terms of how well he and I
would be communicating or we'd be getting feeds from our own
people.
Mr. Shays. Obviously, Governor Keating, there's not a
person in this room that doesn't know the experience you went
through, so you bring tremendous expertise. In that case,
though, it was--which is true in a chemical attack or explosive
or conventional or even nuclear, it's pretty much there. What a
President is wrestling with--what you wrestled with is in the
event it goes outside the city, it goes everywhere. So it
introduces so many gigantic question marks.
But maybe I can ask this of the other panelists as well. If
Congress were to decide the power of a President, or the power
of a Governor in this case, my concern would be that we would
start to get into an issue of, my gosh, we have civil liberties
here, which is obviously important, but then we would try to
write a scenario that would respond to both sides; in the end,
we might lock a President in. Is the ambiguity almost better--
and then I'm going to get to another question. I'm still on
this question. Is the ambiguity almost better because it would
be hard to write--maybe, Dr. Hamre, you could respond first--it
would be hard to write a scenario without getting in gigantic
debates about civil liberties and so on and so forth?
Mr. Hamre. Sure. I tell you what, I walked away from one
conclusion that was overwhelming in my mind, and that is why we
have elected politicians who are national decisionmakers at a
time like this. This is now where all of the issues that are so
central to how we love and want our country, freedom, liberty,
opportunity, security, they all collided together, and we don't
entrust the ultimate authority to make those decisions to
anybody else except politicians, politicians who are
accountable to the electorate, and that's who--the people who
are making the decisions at this exercise were the two people
who had faced the electorate, had worked with the electorate
and felt accountable to the electorate, and that was the
Governor of Oklahoma and the President of the United States.
That's where it really belongs.
I think trying to overly engineer in isolation the solution
to how you're going to handling a crisis when you're in a
wartime environment, this is a wartime environment, any other
way would be a mistake. Leave it to the people who we've
empowered to be making decisions for all of us. I felt in good
company having them make the decisions, personally.
Mr. Shays. Mr. Nunn.
Senator Nunn. I would just add one other thing. I do think
it's important for this subcommittee and the full committee and
the Congress to anticipate some of these broad scenarios in
determining how much authority you want to give to the
President of the United States and Secretary of Defense and
others. We did that when we passed the Nunn-Lugar legislation
in 1991 on the question of bioterrorism and chemical. We gave
more authority and had some waivers of the posse comatitus
statutes back then, and I'm sure that needs updating. It was
done years ago, I believe, under the Reagan administration in
terms of posse comitatus waivers, use of military in nuclear
scenarios.
But I think some of that really needs to be fundamentally
thought through here, because if you don't have any authority,
and the first day the President has to breach what some may
perceive to be the existing law, then where's the line after
that? As hard as it is, I think you need to try to tackle it,
because when you get into that sort of situation, any President
of the United States or any Governor is going to be asking
questions; what is the law, what is my authority? They're going
to ask those questions, and they must, but if they get an
ambiguous answer back and they don't know, they're going to
seize the authority when the lives of millions of people are at
stake.
Mr. Shays. But I'll even say something more. Even if the
law were in contradiction to what a President's instinct was,
if the end result was a very good decision ultimately for the
survival of our Nation, I hope to God that President makes that
decision.
Senator Nunn. I think he would. I think he would need to
explain it to the American people very carefully, though, and I
believe that the question of how far you were into the scenario
would be all important. The hardest thing for a President would
be to take that kind of action before the people knew there was
a serious problem.
Mr. Shays. I am struck in all of the work that we have done
on terrorist issues, that terrorists want to disrupt almost
more than they necessarily want to kill. I mean, the potential
terrorist attack on the tunnels in New York where you would
have flames coming out both ends, the question is, would people
ever go into those tunnels again? And what would that do to the
commerce of New York? Those kind of things have such long-
lasting impact.
The Gilmore Commission, getting to Mr. Gilman's comments
about reorganization and lines of authority and so on,
advocated a central office to coordinate a domestic response to
terrorist attack, with clear budget authority and intelligence
capability.
The Hart-Rudman Commission advocates a centralized office
called the home office. Frankly, it is a term--actually the
more I thought about it, there is so much logic to it. The
Coast Guard and FEMA and so on. But it still raised a question
as to what authority--still have to come to grips with what
authority, budget authority, you know what kind of line
authority do you have and so on.
And, Dr. Hamre, your organization has also called for
centralized coordination. In the end, would all of the
panelists, if there is a disagreement here, agree that we have
to have a much more centralized control with budget authority,
with some line responsibilities, with a clear--more than a drug
czar, with some clear ability to dictate budgets on other
departments if it relates to this issue?
Dr. Hauer.
Mr. Hauer. Yes, I think that is essential. I think that the
fragmentation that we have seen at the Federal level has really
hurt the country's preparedness. The majority of the money over
the last 4 or 5 years has gone into buying toys for local
governments for chemical response, and for the lights and
sirens response.
CDC and HHS in the last several years has worked hard to
try and begin to rebuild the Nation's public health
infrastructure, but that is going to take some time.
The issues that we confront in preparing for biological
terrorism are completely different than the issues we deal with
in preparing for chemical terrorism.
I think it is very important that we have a central focus
at the Federal level that can have this overarching approach
that looks at chemical, biological, nuclear, the use of dirty
bombs is a very big concern at the local level; not nuclear
bombs, but dirty bombs.
We need to have one point of contact. We get mixed messages
from various Federal agencies and have gotten mixed messages.
When I was still in my capacity in New York City, we could call
three or four different Federal agencies, the Justice
Department, FEMA, HHS, and DOD and get different training. The
training was not necessarily consistent. Different programs,
different recommendations, different recommendations on
equipment. And we found it to be very inefficient and very
ineffective. A lot of that is changing. A lot of the program in
DOD has moved over to the Justice Department.
But realistically this should be housed in a central
location, in my opinion, and should be in FEMA, with strong
support from the White House. And then at--the other agencies
should be working through FEMA, so that there is one voice at
the Federal level, one coordinated plan at the Federal level,
and that money flows in a coordinated fashion to the State and
local governments.
Mr. Shays. Let me conclude just with an observation and not
to--Mr. Tierney and I agree on many things, and we sometimes
view it slightly differently.
I have met with Ambassador Mehle on more than one occasion
in Geneva and here during the Clinton administration, and he
had tremendous reservations about the protocol, not the
convention on biological weapons.
In other words, we have a convention that we are not going
to make biological weapons. The protocol is the challenge. How
do you determine whether countries are doing it? And my
observation and my view is that the protocol would provide
minimal inconvenience to the bad guys and ladies and cause
tremendous problems for those who wanted to abide by the system
in an honest way.
So I would have probably predicted that this former
administration would have had gigantic questions about T. Board
Post, the Ambassador who has done the protocol. And I sense
that--at least my observation is that the policy isn't all that
inconsistent.
But time remains, and I could be wrong about it, but that
is my sense.
Mr. Kucinich, would you like us to go to the next panel? Is
that all right?
Mr. Kucinich. Yes.
Mr. Shays. I don't know, there was probably a question or
two that we should have asked that some of you may have
prepared for. Is there a question that you wished we had asked
you that you thought important enough----
Mr. Hamre. We have a wonderful panel that is coming next. I
am not trying to get us off the stage, but you need to hear
from them too, because they are actually the first responders.
If there are questions that come to you that you would like us
to answer, please route them to us and we'll make sure that
everybody gets them and we can answer them.
Mr. Shays. Any other comments? I am very grateful for you,
all of you for being here. And we'll go to the second panel.
Senator Nunn. I would like to thank you and the
subcommittee for your leadership on this issue, not just today
but going back in the past. I think that you have really been
the voice of asking the right questions, you and the
subcommittee. And I congratulate all of you, and hope that you
continue it.
Mr. Shays. Thank you. Very kind of you, Senator.
Our second panel is comprised of those who respond on the
line. Major General William Cugno, Adjutant General of
Connecticut, accompanied by Major General Fred Reese, vice
chief, National Guard Bureau in Connecticut; Major General
Ronald Harrison, Adjutant General of Florida; Dr. James M.
Hughes, Director, National Center for Infectious Diseases,
Centers for Disease Control and Prevention, accompanied by Dr.
James LeDuc, Acting Director, Division of Viral and Rickettsial
Disease--sorry about that--National Center for Infectious
Disease, Centers for Disease Control and Prevention.
If I had the disease, believe me, I would learn the name.
Dr. Patricia Quinlisk, medical director and State
epidemiologist, Iowa Department of Health, and former
president, Council of State and Territorial Epidemiologists;
Dr. Jeffrey S. Duchin, chief, Communicable Disease Control
Epidemiology and Immunization Section, Public Health, Seattle
and King County, WA.
Do we have all of our witnesses here? And I would like to
say to my second panel, thank you for listening to the first
panel. Sometimes we have some so-called name figures. But you
need to know that this panel considers this panel of equal
distinction, and we have the expectation that we will learn as
much, if not more, from all of you as well.
So with that, I would ask you to stand and raise your right
hands, please.
[Witnesses sworn.]
Mr. Shays. Note for the record all of the witnesses and
potential witnesses have responded in the affirmative. And I--
at this time I thank my colleague, Mr. Kucinich, for allowing
us to go to the second panel, because we do need to get on. I
don't know if the gentleman would like to make a comment, and
if not, OK.
We are going to begin with you, General Harrison. And then,
may I ask the line--right down the line this way. This is the
first time that I have ever gone that way. OK, General, you are
on.
STATEMENTS OF MAJOR GENERAL RONALD O. HARRISON, THE ADJUTANT
GENERAL OF FLORIDA; MAJOR GENERAL WILLIAM A. CUGNO, THE
ADJUTANT GENERAL OF CONNECTICUT, ACCOMPANIED BY MAJOR GENERAL
FRED REESE; DR. JAMES HUGHES, DIRECTOR, NATIONAL CENTER FOR
INFECTIOUS DISEASES, CENTERS FOR DISEASE CONTROL AND
PREVENTION, ACCOMPANIED BY DR. JAMES LeDUC, ACTING DIRECTOR,
DIVISION OF VIRAL AND RICKETTSIAL DISEASES, DIRECTOR, NATIONAL
CENTER FOR INFECTIOUS DISEASES; DR. PATRICIA QUINLISK, MEDICAL
DIRECTOR AND STATE EPIDEMIOLOGIST, IOWA DEPARTMENT OF PUBLIC
HEALTH AND FORMER PRESIDENT, COUNCIL AND TERRITORIAL
EPIDEMIOLOGISTS; AND DR. JEFFREY DUCHIN, CHIEF, COMMUNICABLE
DISEASE CONTROL, EPIDEMIOLOGY AND IMMUNIZATION SECTION, PUBLIC
HEALTH, SEATTLE AND KING COUNTY, WA
General Harrison. Mr. Chairman, thank you, and
distinguished members of the subcommittee. I appreciate the
opportunity to address you today and your continued support of
the National Guard.
The United States faces a variety of global security
challenges and concurrent to these global challenges homeland
security contingencies are expected to grow in significance.
For the first time, defense of the American homeland has been
incorporated into the guidelines for the American military
strategy.
The threat of asymmetric attack on critical U.S.
infrastructure and on the Nation's ability to execute war plans
is credible. All components of the United States military must
prepare and be ready for the challenge of the homeland security
mission.
The great strength of the National Guard is its proven
dual-mission capability. As part of the total force, the
Florida Guard--excuse me, the National Guard is fully
integrated and engaged in the joint operational support
contingency operations, military-to-military contact, and
deterrence missions.
The training, organization, equipment and discipline
developed for the Federal mission allows the National Guard to
perform missions throughout the spectrum of conflict, ranging
from the domestic response to the full major theater war.
Homeland security has been a vital role for the National
Guard since the Guard's inceptions over three centuries ago,
and the National Guard recognizes the importance of its
homeland security role, as evidenced by the Chief, National
Guard Bureau's congressional testimony that the Guard must
grant the same stature to the defense of the homeland as the
support we provide to the combat commanders.
The National Guard currently plays a significant role in
the traditional homeland security missions involving response
to natural disasters and civil emergencies. In over 20 States
the State Adjutant General acts not only as the commander of
the Army and Air National Guard units within the State, but
also as the director of State emergency management.
In other States the Adjutant General serves as the
Governor's advisor for military emergency response. Regardless
of the arrangement, the National Guard staffs operate in close
coordination with State and local agencies to prepare for such
incidents and mitigate their effects.
As the National Guard looks to strengthen America's
homeland, the Guard is prepared for homeland security missions
in the areas of air-land defense, crisis consequence
management. Examples of these missions include air sovereignty,
assistance to Customs authorities, Border Patrol and other
agencies, identification and protection of critical assets,
force protection, information operations, military support to
civilian authorities, National Guard weapons of mass
destruction, civil support team programs, facilitation of the
local, State, regional planning incident assessment and
reconnaissance.
The Dark Winter exercise provided a dynamic scenario to
test the emergency response system. Although I was not a
participant in this exercise, my experience as the Adjutant
General of Florida has provided me opportunity to face crisis
and consequence management involving man-made and natural
disasters.
As the Adjutant General, I am the primary military advisor
to the Governor. I do not have emergency management under my
responsibility. In Florida I command 10,000 Army National Guard
soldiers and 2,000 Air National Guard airmen. My soldiers and
airmen provide a unique asset to the State during times of
disaster.
While I cannot comment on the interplay of this exercise, I
can provide a viewpoint that reflects the challenges faced by
the National Guard during a time of crisis such as this.
The National Guard is currently involved in response
planning for weapons of mass incidents such as that posed in
Dark Winter. The Guard constantly reviews its plans and the
Federal response plan regarding weapons of mass destruction or
any similar incident.
At the national planning level, the National Guard Bureau
is fully involved with the Department of Defense weapons of
mass destruction initiatives, and then at the State level each
National Guard is integrated fully into their State's emergency
response plan.
The National Guard is involved in regional planning through
the Emergency Management Assistance Compact [EMAC], a mutual
aid agreement between States that was developed to allow for
the rapid deployment and allocation of National Guard personnel
and equipment to help disaster relief efforts in other States.
Such agreements enable the National Guard to provide
support assets across State boundaries. Thus, the National
Guard is structured at the national and State level to provide
significant military support to civilian authorities.
If a scenario outlined in Dark Winter occurred in Florida,
the Adjutant General would coordinate, deploy and control
National Guard forces and resources to provide military support
to civil authorities.
Unity of effort is crucial in these operations to ensure
that the citizens of the affected area are provided the most
effective support as there may be a requirement. For Federal
military assets, the issue of command and control of these
assets must be addressed.
There have been initiatives to have the Defense Department
broaden and strengthen the existing Joint Forces Command--Joint
Task Force civil support to coordinate military planning,
doctrine and command and control for military support for all
hazards and disasters.
Deployment of such a task force may clarify the command and
control issue. There are alternatives to the deployment of this
task force to manage Federal military assets. In the instance
that the Governor has requested Federal troops without
Federalizing the National Guard, the Adjutant General can
provide reception, staging, onward movement and integration,
RSOI, and have tactical control of Federal troops deployed to
the State for the emergency.
This mission relationship would allow the Governors to
obtain Federal military assistance while maintaining the unique
status and capability they have through control of the National
Guard military assets responding to emergencies, a capability
they would lose if the State's National Guard forces were
Federalized.
Regardless of the ultimate command and control structure
used to employ Federal assets, all Federal, State and local
assets must support the Governor's plan to address this
disaster.
State and local officials normally have the experience,
critical information and local knowledge to ensure Federal
assets are properly employed.
The National Guard will continue to be the Governor's
primary military asset to address emergencies. To improve the
military support process, the National Guard supports the
continued development of enhanced homeland security planning.
Given the Guard's current missions and experience in
homeland security, the Guard should be involved in homeland
security, joint doctrinal development, joint regional
exercises, tests and experimental efforts and expanded liaison
and coordination with Federal agencies.
It is our duty to meet the needs of our fellow citizens
throughout the United States. Homeland security is the
fundamental mission of our military. The National Guard will be
prepared for its role in this mission.
Mr. Chairman, I appreciate the opportunity to address this
prestigious subcommittee, and I look forward to your questions.
[The prepared statement of General Harrison follows:]
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Mr. Shays. Thank you, General Harrison. I appreciate your
testimony. Major Cugno--General. Why did I say Major?
General Cugno. Is there a message there, sir?
Mr. Shays. No message. It is insubordination on my part.
General Cugno. Good afternoon, Mr. Chairman and
distinguished members. On behalf of the nearly 6,000 men and
women who comprise the Connecticut National Guard in the State
Military Department and the over 400,000 men and women of the
National Guard, I want to begin by thanking you for the
opportunity to testify and participate in these hearings on
combating terrorism.
I'll focus my remarks today on the role of the National
Guard during State emergencies, specifically Connecticut, with
my experiences in Connecticut. And I'll include biological
weapons attacks similar to the exercise Dark Winter.
As the Adjutant General of Connecticut, I am entrusted by
the Governor with the authority necessary to carry out the
provisions of our State statutes regarding the militia, the
Connecticut National Guard, and the Office of Emergency
Management.
I serve as the principal advisor to the Governor on
military matters, emergency operations, and civil support.
As the Adjutant General, I have two main responsibilities.
My Federal responsibility is to serve as the custodian of the
CICs, or the Commander in Chiefs' forces on the Federal side,
and I must be ready to deploy combat-ready soldiers and airmen
when the President Federalizes units.
In my State capacity as the Adjutant General, I am the
senior emergency management official for Connecticut. I
exercise this authority through our Connecticut Office of
Emergency Management.
Further, in May 2000 the Governor directed the Military
Department to be the lead State coordinating agency in
Connecticut for counterterrorism, domestic preparedness. This,
incidently, was in response to the Justice Department's request
for such information.
Connecticut, as recently mentioned a moment ago by my
colleague, along with 22 other States, has this Office of
Emergency Management organized within its State Military
Department and under the control of the Adjutant General. The
OEM serves as the principal liaison and/or coordinator to the
Federal office of FEMA, the Federal Emergency Management
Agency, and our State law enforcement officials.
Further, we divided the State into five emergency
management regions. Each regional office maintains regional
specific emergency plans and serves as principal liaison and
coordinator to the 169 towns located throughout the State. In
order to maintain an appropriate level of preparedness, my
department develops and regularly exercises unified emergency
operations plans for a number of potential State emergencies.
We maintain and implement plans for nuclear preparedness,
safety, natural and manmade disasters and civil disturbance.
Next month we will conduct our third hurricane exercise in the
last 2 years in preparing to implement our second WMD exercise
this fall.
In recognition of the uniqueness of each State, I offer my
comments as specific to the State of Connecticut. However, you
will find the roles, relationships and responsibilities that I
described consistent throughout the 50 States. In Connecticut
emergency response contingencies mirror the Federal response
plan and most States' agencies have a role during State
emergencies.
The Governor's role is clearly outlined in both the U.S.
Constitution and the General Statutes of Connecticut. Though
the Governor expects and appreciates the effort of the Federal
Government in preserving the welfare of our citizens and the
infrastructure of our communities, ultimately during
emergencies it is the Governor who is responsible for restoring
normalcy to the citizens of the States.
Politically, and I think most of my Adjutant General
colleagues will agree, Governors consider the emergency
response aspect of their overall duties paramount to
maintaining public confidence and trust.
The National Guard is a unique asset to this country and we
are ideally situated and positioned to play an essential role
in a Dark Winter type scenario. Reliance on the National Guard
has been a cornerstone of American foreign and domestic policy
for over 360 years. I submit to you that the National Guard has
played a vital part in executing homeland security throughout
our rich country's history.
When missioned and properly resourced, the Guard has proven
to play a significant national asset. Accordingly, homeland
security should be seen as an additional mission, not the
mission of the National Guard. As we develop our Nation's
comprehensive plan, the Guard forces who span nationwide nearly
3,300 locations and 2,700 communities should be recognized as
the existent forward deployed military force to this country.
Additionally, the majority of States that have interstate
compacts and regional compacts will provide Governors access to
additional resources. The compacts place responding assets
under the operational control of requesting Governors, thus
preserving the existing incident command structure and allowing
a seamless transition into already existing emergency
management structure within the States. These relationships
make the National Guard uniquely qualified to perform a fusion
role on behalf of the Department of Defense in domestic
assurances.
Though I did not participate in the exercise Dark Winter, I
received detailed and candid feedback from some of my
colleagues who observed it. In their eyes, though the exercise
was useful and beneficial, it strayed from reality.
Although Governor Keating played himself as the Governor,
there was no person playing the role of the Adjutant General,
who again in 23 States commands the State Office of Emergency
Management and in the majority of States is not only a key
participant during emergencies, but also keenly aware of the
role of FEMA, and will often participate through exercises and
routinely practices the State emergency plans.
During State emergencies, the Adjutant General is a key
official for the Governor, and he or she is used as a central
and visible role.
My colleagues remarked that the exercise was federally
centric in nature, and it was their belief that the scenario
facilitators intentionally moved quickly beyond the State
capabilities to meet the demands of the President.
They further indicated that it was evident from the
comments of the Federal players very early in the exercise of
their desire for the President to Federalize the Guard, and a
general lack of understanding of the capability of the Guard to
execute the mission.
Finally, my colleagues informed me that in defense of the
scenario drivers the Federal role players found it difficult
and frustrating to deal with all of the different States, their
capabilities and the various powers granted in these State
statutes regarding civil emergencies.
I can't emphasize enough the realities of what occurs in a
State during emergencies. I know those who advocate a strong
Federal role often underestimate these realities. The Governor
has the ultimate responsibility to decide to restore normalcy
to his or her citizens, and should to the greatest extent
resist relinquishing control.
Dark Winter proponents of a strong Federal role clearly
demonstrate a lack of understanding of statehood and political
realities. I am concerned that Dark Winter is an example of an
exercise developed by respected institutions which have an
important influence on our government's response plans yet fail
to incorporate the most basic realities of State emergency
response and State public policy.
I would suggest for future exercises that we include a full
spectrum of core emergency response officials on all levels.
This would allow participants to exercise their plans and gain
realistic experience of integrating plans at all levels.
To recap, sir, I would like to leave you with the
following. The Governor in my eyes is in charge. We must
challenge adequate resources, Federal resources, to our State
and local first responders through existing emergency
management centers consistent with the Federal response plan.
State agencies possess unique skills and assets which must
be integrated and included in the response plans, and further
exercises to be credible should also include existing State
emergency plans and the National Guard.
Mr. Chairman, thank you once again for inviting me to
testify before your committee and allowing a forum for candid
discussion. I am prepared to answer your questions. Thank you.
[The prepared statement of General Cugno follows:]
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Mr. Shays. Thank you, General.
Dr. Hughes, it is nice to have you back, accompanied by Dr.
LeDuc. Doctor, thank you.
Mr. Hughes. Thank you, Mr. Chairman. And good afternoon. I
am accompanied by Dr. James LeDuc, who is our Acting Director
of our Division of Viral and Rickettsial Diseases. Thank you
for the invitation to update you on CDC's public health
response to the threat of bioterrorism.
I will also briefly address specific activities aimed at
improving national preparedness for a deliberate release of
smallpox virus as simulated in Dark Winter.
In 1998, CDC issued Preventing Emerging Infectious
Diseases: A Strategy for the 21st Century, which emphasizes the
need to be prepared for the unexpected, including antibiotic-
resistant infections, vector-borne diseases such as West Nile
encephalitis, a naturally occurring influenza pandemic, or the
deliberate release of smallpox virus by a terrorist.
Building upon these efforts, last year CDC issued a
strategy outlining steps for strengthening capacities to
protect the Nation against threats of biological and chemical
terrorism. This strategy identified five priority areas for
planning efforts.
The first priority area is preparedness and prevention. CDC
is working to ensure that Federal, State and local public
health communities are prepared to work in coordination with
the medical and emergency response communities to address the
public health consequences of biological and chemical
terrorism.
We are developing performance standards and are helping
States conduct exercises to assess local readiness for
bioterrorism. In addition, CDC with other agencies is
supporting research to address scientific priorities related to
bioterrorism.
CDC, NIH and DOD are pursuing a collaborative research
agenda on smallpox to improve diagnostic capabilities, identify
effective antiviral drugs and identify how the virus causes
illness.
The second priority area is the critically important one of
disease surveillance. Because the initial detection of a
biological terrorist attack will most likely occur at the local
level, it is essential to train members of the health care
community who may be the first to identify and treat victims.
It is also necessary to upgrade the surveillance systems of
State and local health departments and strengthen their
linkages with health care providers so that unusual patterns of
disease can be properly detected. CDC is working with partners
to provide educational materials regarding potential
bioterrorism agents to the medical and public health
communities, including a video on smallpox vaccination
techniques.
Third, to ensure that control strategies and treatment
measures can be implemented promptly, rapid diagnosis will be
critical.
Fourth, a timely response to a biological terrorist event
involves a well-rehearsed plan for detection, epidemiologic
investigation and medical treatment. CDC is addressing this
priority by assisting State and local health agencies in
developing their plans for responding to unusual events, and by
bolstering CDC's capacities within the overall Federal
bioterrorism response effort.
The fifth priority area addresses communication system
needs. In the event of an intentional release of a biological
agent, rapid and secure communications within the public health
system will be especially crucial to ensure a prompt and
coordinated response. CDC is building the Nation's public
health communications infrastructure through the Health Alert
Network. CDC has been addressing these priorities as part of
its bioterrorism preparedness efforts.
The issues that emerged from the recent Dark Winter
exercise reflected similar themes that need to be addressed.
For example, the exercise highlighted the importance of working
with and through the Governors' offices as part of planning and
response efforts. It was also clear that preexisting guidance
regarding strategic use of limited smallpox vaccine stocks in
high risk persons would have accelerated the response.
It was evident that effective communications with the media
and the public during such an emergency will be crucial. CDC
will continue to work with partners to address challenges in
public health preparedness, including those raised at Dark
Winter. For example, work done by CDC staff to model the
effects of control measures such as quarantine and vaccination
in a smallpox outbreak have indicated that both public health
measures are important.
In summary, the best public health strategy to protect the
health of civilians against biological terrorism is the
development, organization and strengthening of public health
surveillance and prevention systems and tools. Not only will
this approach ensure that we are prepared for deliberate
bioterrorist attacks, but it will also improve our national
capacity to promptly detect and control naturally occurring new
or reemerging infectious diseases. A strong and flexible public
health system is the best defense against any disease outbreak.
Thank you very much for your attention. Dr. LeDuc and I
will be happy to answer any questions later.
[The prepared statement of Mr. Hughes follows:]
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Mr. Shays. Dr. LeDuc, I think I sometimes rename you every
time I say your name. I am sorry.
Dr. Quinlisk.
Dr. Quinlisk. Thank you.
Mr. Shays. I hate to tell you, but the only way that I am
going remember that name--never mind.
Dr. Quinlisk. Don't feel bad, almost everyone has trouble
with it.
I am very honored to appear before the subcommittee today.
The comments I will be providing are from the perspective of a
State public health official. I would like to begin with the
concluding points of my written statement.
No. 1, public health needs to be seen as a major player and
as having expertise and as needing therefore to control some
aspects of bioterrorism preparedness response. Thus, public
health needs to be at the table.
Two, the detection of disease, laboratory identification,
investigation of outbreaks, response and rapid secure
communications are all critical but underresourced. These
systems are all multi-use and once installed will be used daily
for more common situations as well as preparing us to respond
to deliberate acts.
Allied fields such as a laboratory, veterinary, medical and
mental health fields need to be assessed and their appropriate
involvement addressed. Communications are critical between
public health entities with other emergency response agencies
and with the public.
I have been asked to address some of the public health
issued identified during the Dark Winter exercise. Even though
I was not part of Dark Winter, I have talked with people who
were and have been part of similar exercises in the past.
Public health issues that have become apparent during these
events include issues surrounding legal authorities and
abilities, communication with other public health entities,
emergency officials and the public and coordination with the
others who are involved in the emergency response.
Legal issues include those surrounding quarantine, both at
the individual and at the community level. Under what authority
is it instituted? If different States implement quarantine
differently, does the Federal Government arbitrate such issues
as who is allowed to break the quarantine?
Also in these days of foot-and-mouth disease, we need to
consider animal and agricultural quarantine.
Communications and coordination concerns arise because, in
part, public health has only been a minor player in the past.
For example, I understand that during Dark Winter there was an
early request for the number of people who had been exposed to
smallpox when public health officials were just beginning their
investigation and had not yet determined this.
I have also found that during these exercises when medical
and scientific information is requested, it is often delivered
in a context not easily understood or used by those nonmedical
people in command. Coordination and communication between these
groups is improving, but I believe we have a long way to go.
With regard to State-Federal interaction, those of us who
are working in bioterrorism in the States, our main Federal
partner is the Centers for Disease Control and Prevention, the
CDC. Almost all Federal funding to the State public health
preparedness comes through the Centers for Disease Control.
Also the CDC provides guidelines, training, communication and
laboratory support.
Very little contact or support comes from any other Federal
agency. Within the last few years, great progress has been made
to create State-to-Federal secure communications and alert
systems such as EPIX and the Health Alert Network. Electronic
reporting of cases of disease from States to CDC is also
improving through the recent and ongoing implementation of the
National Electronic Disease Surveillance System, but these
systems need to be expanded to ensure the communications can be
timely, effective and secure.
Even with rapid electronic reporting and analysis of
disease occurrence, public health still relies heavily on the
medical community to tell us what they are seeing. However,
this means public health must become more visible and better
linked to the medical community. I believe the communications
between all responders and with the public will be a major
issue in any terrorist event.
As stated by CDC's guidelines, effective communications
with the public through the news media will be essential to
limit the terrorist's ability to induce panic and disrupt daily
life.
Many of us in public health are concerned not only about
the health impact of these diseases themselves, but of the
psychological impacts, both during and after an event. In my
opinion, mental health experts need to be at the table during
exercises and incorporated into State and Federal emergency
plans.
Within the public health system, the laboratory is
critical. Public health laboratories must be able to quickly
identify or rule out any organisms potentially involved and to
communicate those results to the appropriate medical and public
health authorities.
Federal funding being distributed by CDC is helping to
address these issues, but again more needs to be done. Also
veterinary laboratories need to be integrated into the
bioterrorism surveillance system.
As a member of the Gilmore Commission, I have been asked to
comment on its findings and recommendations. One of its major
recommendations is the need to focus more on the higher-
probability, lower-consequence situations rather than the
lower-probability, higher-consequence ones. This results in
more focus at the State and local preparedness level.
Finally, I would like to state that continuing to build
toward a robust, comprehensive public health system, we will be
building a multi-use system that will be used for more common
diseases and situations every day. Thus, when a terrorist event
occurs the system will be well-tested, effective and familiar
to those who are involved.
Thank you for the opportunity to provide testimony to you
on this very important matter. I will be pleased to answer any
questions.
[The prepared statement of Dr. Quinlisk follows:]
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Mr. Shays. Thank you, Dr. Quinlisk.
Dr. Duchin.
Dr. Duchin. Good afternoon, Mr. Chairman, members of the
committee. Thank you for this opportunity to speak on the role
of public health professionals in responding to a biological
weapons attack. Because the initial detection of a biological
weapons attack will occur at the local level, a primary role
for public health is the detection and investigation of
illnesses compatible with a biological weapons attack.
Once a potential biological attack is detected, a public
health investigation would follow to confirm the event. In a
suspected or confirmed biological attack, public health
professionals must determine the location and magnitude of the
problem, identify the exposed population in order to target
prevention and treatment, and monitor the extent of the
outbreak.
In order to limit the spread of disease in the population,
public health investigators must identify for treatment or
quarantine persons exposed to biological agent.
Currently, many public health agencies are functioning with
the minimum amount of staff required to perform routine day-to-
day operations with little reserve capacity to respond to
naturally occurring communicable disease outbreaks of modest
scope.
An effective response to a biological weapons attack
requires a strong public health capacity at the local and State
level, including advanced surveillance system architecture and
information management technology. Improvements in surveillance
and information systems are necessary to improve communications
between health departments and hospitals, laboratories,
emergency management and emergency medical systems.
For example, local public health professionals were
concerned that our usual surveillance system would not rapidly
detect a biological weapons attack during the 1999 World Trade
Organization Ministerial Conference in Seattle.
Current disease surveillance relies on reports of
laboratory confirmed diseases submitted from health care
providers and laboratories, with a time delay associated with
both the identification of the agent of disease and the
processing of reports.
To enhance our ability to detect a potential biological
weapons attack, assistance was requested from the Centers for
Disease Control and Prevention for design and staffing of a
special syndromic surveillance system that once implemented the
enhanced surveillance system allowed us to monitor clinical
visits to area emergency departments on an around-the-clock
basis.
After the conference, the enhanced surveillance system was
dismantled. Ongoing optimal detection of potential biological
weapons attacks will require sustainable improvements in
surveillance systems architecture and methods.
The second major role for local public health professionals
is to facilitate the medical response to a biological weapons
attack. This includes assuring evaluation, treatment, and
preventive measures for the exposed population, including
possible mass vaccination and delivery of appropriate resources
to local health care facilities.
The first responders in the event of a biological weapons
attack will be health care professionals in hospitals and
emergency departments and public health departments, not the
traditional first responders such as firefighters and law
enforcement.
Local medical systems will be rapidly overwhelmed with the
response to a biological weapons attack. The ability of health
care institutions to respond to unanticipated increases in the
numbers of patients with communicable diseases associated with
even a relatively small naturally occurring outbreak is
limited.
Prioritization of the delivery of Federal resources is
needed to effectively engage health care facilities and medical
professionals with public health departments in planning and
response activities for a biological weapons attack.
A third key role of public health is to provide accurate,
reliable information to local, State and Federal agencies,
medical professionals and political leaders and the public.
In summary, public health professionals, along with local
health care institutions and medical professionals are the
front line responders to a biological weapons attack. Key roles
for public health include detecting, describing and monitoring
the course of a biological weapons attack, assuring an adequate
community-wide medical response and providing needed
information and effective communication to all parties involved
in response activities and the public.
Improvements in our ability to effectively respond to a
biological weapons attack are needed and can be achieved by
strengthening public health surveillance and epidemiological
capacity and through enhancing information and communication
systems at the local and State level. Effectively engaging the
medical community in biological weapons response planning
should be given high priority.
Thank you for the opportunity to testify today.
[The prepared statement of Dr. Duchin follows:]
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Mr. Gilman. Mr. Chairman.
Mr. Shays. First, let me just thank Dr. Duchin and all of
the panelists.
Yes, Mr. Gilman.
Mr. Gilman. If I might just interrupt. I regret the
interruption, but I did want to introduce a group that you and
I have both met with earlier today. These are graduate students
from NYU Wagner School, Graduate School of Public Service. They
are in our back row here. They are from Japan, Taiwan, Peru,
Mozambique, and they are here studying public
administration,and I would like to welcome them to our
committee.
Mr. Shays. Thanks. I would like to welcome them. Some of
them smiled when you said I addressed them. I hope to have the
opportunity after this hearing to visit with them.
Mr. Gilman. Thank you, Mr. Chairman.
Mr. Shays. Mr. Tierney.
Mr. Tierney. Thank you. Well, in keeping with the desire to
be able to spend some time and get this over, I only have a
couple of brief questions.
Dr. Duchin or Dr. Quinlisk, perhaps you can answer that.
What would you assess the current training level of medical
personnel, local medical personnel for identifying these types
of incidents and for what they are, recognizing what they are
and for setting a course of action immediately at the local
level?
Dr. Duchin. I'll take a crack at that. I am in addition to
the communicable disease officer a physician on the faculty of
the University of Washington in the Infectious Disease
Department, and I can tell you that there is no formalized
training currently for health care professionals in the medical
field to recognize agents of biowarfare. We have tried to raise
the awareness of health care providers, physicians and nurses
in our community using public information, Intranet,
newsletters and so on. But the key I think is that this needs
to be institutionalized so that trainees receive this
information as part of their formal medical education.
Mr. Tierney. Would you focus that on training medical
students as they come through school and on other medical
personnel as they get retraining or take courses at that time,
or would you separately, alternatively or in addition train
health agents in different communities?
Dr. Duchin. Did you say health agents?
Mr. Tierney. Health agents.
Dr. Duchin. I think it is all. You can't start too early.
It is important to raise the awareness at the medical student
level and to reinforce the message throughout the training
period, as well as reach those who are out of training and
currently in practice in the community with continuing
education.
Dr. Quinlisk. I would like to make another point there. We
talk about identification of it, but the identification will do
no good if it has not been reported to somebody, and one of the
biggest problems that I see is not that somebody recognizes a
disease but they remember to pick up the phone and tell someone
about it. So I think there is two things there that we need to
do training on.
Mr. Tierney. To train them who to contact. That would be
somebody at the CDC or something like that?
Dr. Quinlisk. Usually the local health department would be
the appropriate person to respond and then it goes up the
ladder, and that communication works quite well. It is the
getting from the health care practitioner into the public
health system where I think the biggest barrier is.
Mr. Tierney. How important do you think it is that people
within the health profession, probably the health departments
of these areas, learn to deal with the media in a situation
like this? I can see where a situation gets totally out of hand
because somebody is inexperienced dealing with the media,
because they are going to come down like locusts once there is
any hint of this type of information. And how would you
recommend that we deal with that issue?
Dr. Quinlisk. I can speak a little bit about--the scenario
that I think would be best when dealing with any kind of either
potential bioterrorist or outbreak of any kind is do whatever
you need to do to make sure that all of the messages are
consistent, that they are very clear and they are presented to
the public in language that they can understand.
What I would envision in something like this would be the
Governor standing in front of the microphones with the
appropriate people behind him or her to then step up to the
microphone when appropriate questions were asked.
That way everybody in that room, every message going out to
the media is consistent and clear. I think you do great damage
to public confidence if you start giving conflicting
information that is not clear.
Mr. Tierney. Thank you very much.
Mr. Shays. I thank the gentleman. Mr. Gilman.
Mr. Gilman. Thank you, Mr. Chairman. I regret that I was
with our graduate students in the outer room, and I just have
one major question.
We addressed the last panel with this question. Since it is
a troubling issue, and since we have done very little in
preparation for it, let me ask this panel. Who do you think
would be the best comprehensive agency to handle this matter in
our Federal Government structure, and to be effective? I ask
that to the whole panel. General.
General Harrison. Yes, sir. I would be glad to take that
one on. I heard the other panel. And I believe that FEMA, in
the configuration that has been proposed, certainly has a lot
to offer there, and I would say that for a couple of reasons.
One, the operation of FEMA in the last 8 or 10 years,
particularly since Hurricane Andrew, where we had a lot of
difficulty of coordination of State agencies and Federal
agencies, has come a long way.
I think that the fact that they are organized already into
emergency support functions at the Federal level to coordinate
agencies of the Federal Government, and that most States are
now organized in a like manner, emergency support functions in
the State that will track what FEMA does, as they coordinate
Federal and State agencies together, really lends a lot of
credibility to FEMA having this kind of organization that is
already in play.
Perhaps there are better models. But for right now, to
start today, I would envision, because of the emergency support
functions, this would be the best.
Mr. Gilman. They would need a lot of training on this
issue, I take it?
General Harrison. They would, sir. But I believe that there
is a model that is still good for this. The catastrophic
emergencies that have been had, where the coordination is still
required, it may not be the same requirements in terms of
chemical or biological warfare, or chemical or biological
incident. But the model is still the same and the coordination
is going to be the same, and things are in place today to do
that.
Mr. Gilman. General, did you have something further to add?
General Cugno. Yes, sir, I do. I, too, would agree with
FEMA. Recently with the establishment of the Office of National
Preparedness I think it is a move in the right track within
FEMA.
Second, I think there is a proven track record of the
Federal response plan. I think we have organizations like the
Adjutant Generals Association, the National Guard Association,
the National Emergency Management Association that would
support that, with a central organization to deal with the
consequences.
And I am not suggesting the law enforcement crisis side of
this, but simply the consequence side of it. It is a familiar
program, practice, programmed and resourced.
To answer the second part of your question, with the
training, I think part of the requirements of the future deal
with the training aspects and resources necessary for training.
On the previous panel there was a gentleman here that
mentioned the sirens and whistles and bells at the first
responder's portion. I think that there is some truth to that.
We are talking about the strategic level of planning at the
national level. It has got great impact on what States could
expect and how they would report. So FEMA is the answer as far
as we are concerned.
Mr. Gilman. Before leaving our two Generals, has the
military engaged in preparation for biological warfare and
chemical warfare, in preparation for our national defense?
General Harrison. Yes, sir. I speak for the military as
from the National Guard perspective. We are, and I know that
you know the civil support teams are engaged in this, in most
States. Not most States yet, but 10 States, I think there are
now more than 20, that are engaged in this with civil support
teams and are in training for this.
In addition to that, I think the majority of the States
would like to or are doing planning for their contingencies in
case something were to happen in their major metropolitan
areas, and certainly we are in Florida, and I think that most
of them are anticipating a contingency.
Mr. Gilman. How about Connecticut, General Cugno?
General Cugno. Yes. I think from the basic standpoint of
soldiering skills, you would also find that chemical,
biological and radiological training remains a basic core part
of every soldier that jumps into uniform. That is not unique in
Connecticut, that is part of the Department of Defense
requirements for the basics of soldiering skills.
Mr. Gilman. Dr. Hughes.
Mr. Hughes. Yes, I agree also with FEMA in the leadership
role. We in public health have a long history of working with
FEMA in the context of their response to natural disasters to
help them deal with infectious disease issues that inevitably
arise, And I would see us continuing to do that in this area of
bioterrorism by providing expertise and advice and diagnostic
patient management and treatment.
Mr. Gilman. Dr. LeDuc.
Dr. LeDuc. Yes, sir. I agree with Dr. Hughes.
Mr. Shays. Good thing.
Mr. Gilman. Dr. Quinlisk.
Dr. Quinlisk. I think what I would rather do is address
whoever it is that is put into authority over this issue. One
of the things that I would want to make sure that they are very
aware of is it not going to be business as usual. Biological
attacks act very, very differently than a hurricane, an
explosion, a chemical spill. And whoever it is that deals with
it has got to understand that and not think, oh, I can rely on
my old methods, the usual way of doing things, and that is
going to be good enough, because it is not.
Mr. Gilman. Thank you. Dr. Duchin.
Dr. Duchin. I agree with the previous panelists that if
FEMA does take over this role, they will need to work closely
with HHS and others who have expertise in the management of
biological issues.
Mr. Gilman. I thank our panelists. Thank you, Mr. Chairman.
Mr. Shays. I thank the gentleman.
When I was listening to you, General Harrison, it seemed to
me that you were making a strong statement for the role of the
Guard in homeland defense. And, General Cugno, I heard from you
that joint exercises to, quote-unquote, fight as we train are
absolutely essential. That was one of the key points I heard
from you.
And, Dr. Hughes, that surveillance and communication are
absolutely vital.
Dr. Quinlisk, I heard from you something that surprises me
in a way because it seems like we wouldn't have to say it, but
it is the sad fact that you were saying that public health is a
key player and should be at the table. And it is like, you
know, what does it take? Do we need to slap ourselves around
here? You are clearly an essential role here. You are going to
hopefully make the bomb harmless ultimately.
And Dr. Duchin, the message I heard from you is that State
health care needs help, money and training, and that was kind
of the message that I was hearing from all of you.
I then said, you know, well, you all are first line
defenders. But I thought, where are the police, the fire, and
so on? When I was asking the staff why both of you, you know,
the military and the health care, why not all of the others,
they may want to jump in because I may not have heard them
correctly, but basically that your roles are still unclear to
some, and that they need to be. Obviously, you know, the police
are just going to respond. I mean they are going to respond.
And so the reason, at least from my staff's standpoint, is
that central roles of both the military and health, but truly
trying to see how you fit in when you have to take charge over
local activities and so on, and so in that perspective is a
little clearer to me why this panel is comprised the way that
we are.
General Harrison, your office recently produced what my
staff says is a very--they don't pass this out lightly--a very
thoughtful analysis of national security roles for the National
Guard, and I would like you to describe the issues you raised
and the recommendations that were made in here. I want to give
you an opportunity to just briefly talk about this if you would
like. And if I could, I would just ask unanimous consent that
this white paper, National Security Roles for the National
Guard, by Colonel Michael Flemming and Chief Warrant Officer
Candace L. Graves be introduced into the record.
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Mr. Shays. I just want you to know that our staff thought
that they did a very thoughtful job. Just give you an
opportunity to mention it.
General Harrison. Thank you, sir.
Mr. Shays. Would you like to make any comment about this
report?
General Harrison. I would. I think that as a State we felt
like we needed to come to grips with what we had been talking
about and putting on paper regarding the response that we would
give to any weapons of mass destruction or biological, chemical
or radiological or certainly bombing.
But to really look at biological particularly, how would we
do that, and what is different than we--that the doctor just
mentioned, that is certainly different than what we would do
with a natural disaster in many cases, in most cases. We put
that together, realizing though that the model that we use for
a catastrophic event still has some basis for us to begin our
work, very hard to train for some of these biological incidents
in the field, and recognizing that they can go beyond State
lines, and we would have a lot more coordination to do. And it
raises to--it escalates to a Federal level.
The key points of our paper were this: That the National
Guard is in support of our local authorities, working under the
Governor's plan. That may escalate beyond that, but initially
we are going to be tasked with supporting the local authorities
under the direction of the Governor.
And many times people feel like the Guard is only in the
law enforcement area, and we get into posse comitatus and all
of the other things. And I would like to tell the committee,
the subcommittee, that I was the Adjutant General when we had
Hurricane Andrew, a totally different perspective than we would
have in most natural disasters. But when we did that, the
Florida National Guard stayed on active duty under the
Governor, and the Federal response from the military brought
23,000 Federal military into the State. And it worked because
we all worked under the Governor's plan and tried to do what
the Governor thought was the right thing to do in his State.
And that is for me the key. And it is not all--and our
paper was trying to describe that--it is not all law
enforcement. There are a whole lot of things that the Federal
military can do when they come in to help us or the Reserve and
other State Guards besides worrying about the security: Food
delivery and recovery of contaminated areas and testing of
water and water purification. And there are just a whole lot of
these, shelter management and search and rescue, language
support, and the list goes on.
So I think it is instructive for us to recognize that there
are a lot of things that the Federal military and the State
military can do, but is it all done under the direction of the
Governor's plan and what he needs to get accomplished. That
would be a very quick summary, sir, of our paper.
Mr. Shays. Thank you.
General Cugno, what do you see--first, let me say to you, I
appreciated that the Connecticut Department of Emergency
Management helped the Table Talk Exercise in the Greater
Bridgeport Area. We did a chemical--basically an attack on an
Amtrak train and what happened to the first responders and all
of the challenges that we encountered, and health care showed
up right away, because everybody had all of this fancy
equipment and health care providers had a black telephone.
You know, it is like weird, the difference. And you--and I
think health care providers are in my judgment the stepchild
here. I mean, they just would know that--no reflection on step-
children actually--but not given the attention that they need.
So I thank you for being part of that funding, but what do
you see are the advantages of a State Adjutant General also
exercising control over the emergency management functions?
General Cugno. Clearly I see a great advantage, at least in
our State, having experienced both sides of this. We
reorganized on July 1, 1999, where the Adjutant General became
the responsible agent for the Office of Emergency Management.
Mr. Shays. Was that a State----
General Cugno. Yes, sir. It was legislated and signed into
law by Governor Rowland. It was based upon--there had been a
move across the country. I think there were some that were
going to that. It provided the resources in our particular case
in one building, close proximity to the Capitol. But it also
gave all of the emergency operations that had been previously
put together by the Military Department a clear focus on a
direction that the Governor was looking to go, and it was to
minimize time and maximize resources to affected areas as
quickly as we possibly could.
Our experience with the FEMA folks was incredible, and it's
worked quite well. I am very comfortable with it. The Governor
is very comfortable with it. And we find that in emergency
operations such as this, we're able to interact with the Fed
side because of the existing Federal response plan, where there
is a Federal coordinating official, there's a State
coordinating official, and those are designated individuals.
Additionally, there are liaison people from other branches of
the service.
There are parts that are missing that still require
attention, and the Adjutant General's Association is clearly
aware of them and has worked to this end. Part of it is under
the new program mandated by the President with the National
Preparedness Office's part of the FEMA, how that will integrate
with the States and how it will integrate also when resources
are deployed from the Commanding General of civil support,
General Lawlers' forces, when they come into a State and how
they'll be--whether the State is currently under the control of
Emergency Management by the Adjutant General or by a stand-
alone agency, how it will integrate Federal resources, how it
will integrate the Commanding General's forces and other
resources that he brings with it, whether active component or
reserve component.
The National Guard Bureau, we believe that's not part of
the State but part of the Federal entity in Washington here at
the Readiness Center and at the Pentagon.
One of the reasons I had asked General Reese--and discussed
it with him--to come is that at some point, if the Congress
would like, we are prepared to provide to the Congress--it's a
one-page brief sheet, and it follows a model that Congress has
authorized in the counterdrug program on how we take this
complex issue of Federal rights, State rights and resources,
and come up with suggestions to better minimize overhead,
minimize bureaucracies, and get resources to the front. We're
prepared to do that when you'd like.
Mr. Shays. Thank you, General.
Dr. Hughes, the--I'd like to know what is being done to
improve the electronic reporting of disease between local and
State governments and between States and the Federal
Government. Let me just preface it by saying what became very
clear to us early on when we started to do this work on
biological threat, pathogens and so on, is that particularly in
our larger cities, we are continuing monitoring to see if there
is an outbreak of both natural causes or man-made, and so how
we report this information, the fact that we report it and so
on, is I think obviously of key interest. Maybe you could
respond to it.
Dr. Hughes. Thank you very much for asking that. It's a
very important question, and I think Dr. Duchin and Dr.
Quinlisk would like to add something to what I have to say too.
But to digress for a moment----
Mr. Shays. You may digress.
Dr. Hughes [continuing]. Let me point out that in a Dark
Winter scenario, you don't want to rely on electronic reporting
to pick that up. It's absolutely critical there that you have
the alert health care provider who's trained and prepared--you
want to recognize that first case. You don't want to, as in the
scenario, after there are 20 or 30, somebody figures out that
something's going on. You have to get the first case and that
will require more conventional but rapid communication.
Mr. Shays. But it's been in the incubator for 8 or 9 days;
in other words, the disease hit over a week before.
Dr. Hughes. I'm sorry?
Mr. Shays. The disease hit over a week before in terms of
smallpox.
Dr. Hughes. The exposure--yes, that's--when you think about
infectious diseases, as you know, we have this period called
the incubation period from onset----
Mr. Shays. That will vary depending on the disease?
Dr. Hughes. It will vary depending upon the disease, and
for smallpox it's typically 10, 12, 14 days. If you have a
common exposure, as I suspect was the case in Dark Winter, you
want to get that case. You want to get it confirmed. You want
to alert the health care community to the fact that they see
additional cases, and that's where some of the electronic
notification can come in.
Mr. Shays. But that first case isn't necessarily the first
hit. I mean the incubation could be different.
Dr. Hughes. True.
Mr. Shays. So that person could end up being in a town that
wasn't where they were exposed.
Dr. Hughes. Yes, exactly. But you want--you want a health
care provider who sees somebody who's sick with a febrile
illness that's beginning to develop with a rash, you want
them--in the current climate, you want them to be sensitized to
the fact that this could possibly be something very bad and
they need to then move rapidly to ensure that confirmatory
diagnosis takes place.
That was one thing that I was happy to hear occurred in
Dark Winter, but you should not take that for granted, the
recognition, the notification, the shipment of specimens, the
receipt by people who are trained, who have containment
facilities they can work in and modern molecular tests that
they can do.
So all of that is absolutely critical, but you want to get
that first case, so when you get a second or third case, you
then go back and get, as Dr. Hamburg had said, you get the
histories and you see what these people had in common so that
you get that exposure, that common exposure nailed down right
away.
I think you could see how that might have helped in the
management of Dark Winter. It might not have, but I would argue
that it probably would have.
Now, electronic surveillance and notification, it needs to
go both ways from local to State to Federal and back. There are
efforts currently around, what we call the National Electronic
Disease Surveillance System, a standardized approach to
surveillance of infectious diseases and other diseases
occurring in the United States that we are making an investment
in. There's a tremendous amount of work that needs to be done
to make this a reality, however.
The other piece of this was alluded to by one or two of the
previous speakers, and that is a system that's now in place
called EPIX that would be extremely valuable I think in a Dark
Winter-like scenario. This is a secure communication network
linking us at CDC with Dr. Quinlisk and her colleagues at the
State level, and Dr. Duchin and colleagues at the local public
health level, where information or late--just breaking
information on outbreak scenarios can be rapidly shared in a
secure manner with people who need to know about it.
So a lot of work needs to be done there. It's critically
important.
Mr. Shays. I saw a nodding of the head, Dr. Quinlisk. Did
you want to say anything or just report that you nodded your
head?
Dr. Quinlisk. I would just second everything that Dr.
Hughes said, and I think we're doing a very good job from the
State to Federal level. Things are coming along, we're working
on it.
The biggest problem I see is from the local to the State
level. We're still back 20 years ago in many States. In my own
State, I still get our own public health laboratory reporting
to me by pieces of paper they send through the mail.
Mr. Shays. My staff said yikes. Is that what you said?
OK. Let me kind of bring this panel and hearing to a close
by just asking--I'm a little concerned. This is such an open-
ended question; so maybe you could be selective in what you
would respond to, Dr. Quinlisk or Dr. Duchin. What constraints
confront health care professionals to adequately prepare for
catastrophic events? If you could just give me the key
constraints.
Dr. Duchin. I think, speaking as an ex-emergency department
physician and a current practitioner in infectious diseases, I
think resources, I think health care providers and health care
institutions don't feel that they have the time to devote right
now for preparing for this issue. They are constrained by their
own financial needs.
Mr. Shays. Financial needs, just the workload----
Dr. Duchin. Their workload. They need to--their income.
They need to see patients and take care of the bottom line, and
I think what we're asking them to do is something--an unfunded
mandate-type of issue where we're asking them to train for
something that's new and different. We're asking them to learn
a new body of knowledge, and then to integrate a system that's
going to implement a response without giving them any resources
with which to do that.
Mr. Shays. I'm--you all didn't participate in the Dark
Winter, but I'm just struck by the fact that we are woefully
unprepared on the health side. I feel like the--there are lines
of authority questions for our Adjutant Generals, but on the
health care side it's just--it clearly, I think, of all the
things that I've thought about today--I guess I've learned a
lot, but I'm most concerned about startabilty, particularly in
a case like smallpox, to just respond.
Dr. Hughes, maybe you could just comment on the
stockpiling, I mean the 12 million, for instance. Are we going
to have to just really reassess our stockpiling issues?
Dr. Hughes. Well, let me focus on just the smallpox vaccine
component of the stockpiling, and Dr. LeDuc is much more
familiar with the details of this than I and he will want to
chip in here. There are actually about 15 million doses of
vaccine available.
Mr. Shays. How many?
Dr. Hughes. About 15 million.
Mr. Shays. Which isn't a lot.
Dr. Hughes. No, it's not a lot. And we would like more and
Dr. LeDuc can talk about some of the specifics in terms of how
we're moving to have more produced.
Mr. Shays. It lasts about 10 years, the vaccine?
Dr. Hughes. Well, the shelf life is probably even greater
than that. Let me just----
Mr. Shays. I'd like you to respond, Dr. LeDuc, but what I'm
being told is this is a vaccine that as long as the symptoms
haven't appeared the vaccine has impact, but once the symptoms
appear--but it can spread before the symptoms appear. No or
yes?
Dr. Hughes. No. No.
Mr. Shays. So that's the good news in the sense--in other
words, it's not being spread before the symptoms show up?
Dr. Hughes. Right. Dr. Henderson, if he were here, would
say from his experience which was extensive, obviously,
administration of smallpox vaccine within 3 to 4 days after
exposure would prevent illness.
Mr. Shays. So the biggest incentive in this case would be
just to give as many people the vaccine as possible?
Dr. Hughes. But given the fact that we're always going to
be constrained in the amount of vaccine available, you want to
be sure you're targeting the vaccine to----
Mr. Shays. Because we're under a scenario where we have
limited supply. But I could even see a scenario where you would
have a world supply and you'd ship it by Concord jet if you had
to, but you'd get it quick.
Dr. Hughes. Yes. And I think there are a lot of countries
who would like that. But the current vaccine and the second
generation, as was pointed out, does have some side effects. So
you have to be cognizant that there is some risk----
Mr. Shays. Well, all vaccines have side effects.
Dr. Hughes. Yes, but smallpox vaccine probably more than
others.
Mr. Shays. We won't get to anthrax. We won't go there.
Dr. Hughes. We don't have time.
Mr. Shays. OK. Doctor.
Dr. LeDuc. Thank you. Dr. Hughes asked me to come just to
give you--be available for a brief update on the actual----
Mr. Shays. He wanted moral support.
Dr. LeDuc. Well, and I've done my best, although I feel a
little bit like the party crasher in the middle of the table
and not saying anything.
Mr. Shays. My feeling is this. The one who speaks the least
probably has more time to think about the answer. So I'm
expecting a really good answer.
Dr. LeDuc. Thank you for the added pressure. I think you're
familiar with the contract in place. There are a couple of
important issues. No. 1, this is a new vaccine from the
regulatory perspective. It's a whole new manufacturing process.
So there are going to be some hurdles to overcome, and we're
already seeing some of those.
No. 2, we have designed this contract so we have a
sustained capacity to make the vaccine over a long period of
time. The contract actually extends through the year 2020; so
we have estimated a 5-year shelf life. We've projected
replacing that. We've also projected that vaccine would
accumulate so at the end of the 20 years we would produce a
total of something like 160 million doses. The idea is to have
40 million doses on hand as quickly as possible.
To make a vaccine, this particular vaccine, there really
are two parallel tracts that we have to follow. No. 1, just the
nuts and bolts of how do you make that; and, No. 2, the
regulatory side, does this vaccine do what we expect it to do
in protecting people?
On the nuts and bolts, making the vaccine, we are I think
in very good shape. We begin vaccine lot production next month.
That should be done in about 2 months, and that will be used
for the initial safety trials.
As soon as that production is finished, we will then begin
making three full-scale manufacturing production lots, and that
will be done toward the end of the next year, about October
2002. At that time, we'll have the capacity to make the
vaccine.
Each lot is a little over 3 million doses. It's about 3.3
or 3.4 million doses per lot. We can make roughly one of those
per month, if pressed. We could scale up that. This is all
limited, by and large, by equipment. If we wanted to double
that, we'd just buy more equipment. We can do that.
On the human side, proving that vaccine actually works,
that will require formal testing. And we're working very
closely with the FDA to set those tests up, and in fact we meet
with them on August 15, next month, to have what's called a
pre-IND meeting. This is the first formal meeting to tell them
what we're going to do. We then hope to file the IND in October
or so.
As I mentioned, we'll go through the phase I safety trials.
Those will start actually in December of this year and will
take about 4 months to be completed. Then we'll go into the
phase II and phase III safety and efficacy trials, and those
will take about 3 years. They should be done in October 2003
and then we'll file the licensing. So, early 2004 we should
have the licensed product.
Mr. Shays. Thank you. If you think it is an exercise
without a need, then it becomes an exercise without a need. But
if you think there is the real possibility that there could be
an attack like this, every minute that you spend on this issue
is extraordinarily valuable, and that's kind of where I come
down.
I just want to invite any of our witnesses to--any of you,
to ask yourself a question that we should have asked, and
answer it if you'd like to. Is there--otherwise we will just
conclude there.
General, is there a question that you wish we had asked or
we should have asked?
Mr. Harrison. Well, I would maybe just a reiteration, sir,
part of what I have said. The reason that the National Guard is
capable of doing what is needed to be done is because we're
organized and trained and equipped and disciplined to do the
warfighting anywhere in the world speaks clearly for me to the
fact that this is a mission for us, but it is not the primary
mission. We need to stay in the warfighting business to be able
to do this as we do now.
And the last is that it's very important that we recognize
that Federalization of the National Guard is probably not the
way to do things--I would never say never--but not the way to
do things, and that the flexibility--and really I would say
this. There's a synergistic effect. If and when the Federal
military has to come in and work and the State National Guard
is still on State active duty, there's a synergy that is
created to really get more work because of the missions.
Mr. Shays. I should have made that point. That point came
through loud and clear, and I think it needed to be emphasized,
and I thank you for that.
Dr. Harrison. Thank you, sir.
Mr. Shays. Major Cugno. General. Gosh, I don't--I'm a bad
speller. I see MG and I think Major. I know it's MG but----
General Cugno. Sir, the only thing I would like to leave
you with is in every State there's an emergency plan, the
Governor is actively involved with it. That emergency plan is
existing, it's practiced. Regardless of what the catastrophe
is, the consequences of that catastrophe may have been planned
for. It integrates law enforcement officials, medical
facilities, medical assets and resources, in addition to the
National Guard and the resources. In every State's compact, it
gives the commander or Governor the ability to reach out and
touch additional assets, future operations, plannings--and
exercises at the Federal level have to recognize that.
I think if not, we really don't get an accurate picture of
what the consequences or abilities are of a State.
Mr. Shays. Thank you, sir. Anybody else? Dr. Hughes or
anybody else?
Dr. Hughes. Well, I would say briefly in this context of
bioterrorism, prevention is critical. If that fails, early
detection and rapid response in a coordinated way is critical.
And then I'd like to just end by acknowledging what a
number of people pointed out in the previous panel. This lack
of surge capacity is a critical issue whether we're dealing
with naturally occurring disease, the annual influenza
epidemic, let alone a flu pandemic on the one hand or a
bioterrorism----
Mr. Shays. That suggests government intervention to allow
for that surge capability, doesn't it?
Dr. Hughes. Pardon?
Mr. Shays. It suggests government intervention to--
certainly the stockpiling would be at government expense.
Dr. Hughes. Well, there's certainly a need for government
leadership and investment, yes.
Mr. Shays. Are you suggesting that there may be imaginative
ways to--when you say surge capability, that tells me we need
to have excess supply.
Dr. Hughes. We have--no.
Mr. Shays. No need to have extra supply, additional supply,
that you wouldn't think you would need on a day-to-day basis?
Dr. Hughes. Well, yes. I mean it comes up in the noncontext
of the health care setting, just beds for patients. You know,
each year there are hospitals that close during the influenza
season. We're faced with shortages and delays in vaccines, as
you know. We have shortages of some antibiotics, even including
penicillin. Who could think that would happen in the United
States?
Sometimes we run into problems of shortages even with
diagnostic tests. So that's the point.
Mr. Shays. Anyone else?
Dr. Quinlisk. I would just like to say thank you for
bringing the issue of public health to this table. And I
appreciate the opportunity to speak to you today, and I would
just like to say that public health needs to be involved not
only in biological terrorism, which seems to be the place we
are seeing more often today, but not to forget chemical and
radiological and other types of terrorism as well.
Mr. Shays. Thank you.
Dr. Duchin, I want to thank you. Evidently you appeared on
very short notice when we had a cancellation, and it was
thoughtful for you to participate and your contribution.
Dr. Duchin. It was my pleasure to be here. Thank you.
Mr. Shays. Thank you very much. You're all patient. It's
nearly 6 o'clock and this committee learned a lot. Thank you
for your participation. This hearing stands adjourned.
[Whereupon, at 5:50 p.m., the subcommittee was adjourned.]
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