    [Senate Hearing 107-507]
    [From the U.S. Government Publishing Office]

                                                            S. Hrg. 107-507

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

    =======================================================================

                                    HEARING

                                   before the

                                  COMMITTEE ON
                              GOVERNMENTAL AFFAIRS
                              UNITED STATES SENATE

                          ONE HUNDRED SEVENTH CONGRESS

                                 SECOND SESSION

                                   __________

                                 APRIL 18, 2002

                                   __________

          Printed for the use of the Committee on Governmental Affairs

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                                WASHINGTON : 2002
    ____________________________________________________________________________
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                       COMMITTEE ON GOVERNMENTAL AFFAIRS

                   JOSEPH I. LIEBERMAN, Connecticut, Chairman
    CARL LEVIN, Michigan                 FRED THOMPSON, Tennessee
    DANIEL K. AKAKA, Hawaii              TED STEVENS, Alaska
    RICHARD J. DURBIN, Illinois          SUSAN M. COLLINS, Maine
    ROBERT G. TORRICELLI, New Jersey     GEORGE V. VOINOVICH, Ohio
    MAX CLELAND, Georgia                 PETE V. DOMENICI, New Mexico
    THOMAS R. CARPER, Delaware           THAD COCHRAN, Mississippi
    JEAN CARNAHAN, Missouri              ROBERT F. BENNETT, Utah
    MARK DAYTON, Minnesota               JIM BUNNING, Kentucky
               Joyce A. Rechtschaffen, Staff Director and Counsel
                Michael A. Alexander, Professional Staff Member
         Michelle McMurray, Congressional Fellow for Senator Lieberman
                  Richard A. Hertling, Minority Staff Director
              Jayson P. Roehl, Minority Professional Staff Member
             Morgan P. Muchnick, Minority Professional Staff Member
                         Darla D. Cassell, Chief Clerk

                                C O N T E N T S

                                     ------
    Opening statement:
                                                                       Page
        Senator Lieberman............................................     1
        Senator Collins..............................................     3
        Senator Cleland..............................................     4
        Senator Bunning..............................................     7
        Senator Akaka................................................     8

                                   WITNESSES
                            Thursday, April 18, 2002

    Hon. Tommy G. Thompson, Secretary, U.S. Department of Health and
      Human Services, accompanied by Jerry Hauer.....................    10
    Margaret A. Hamburg, M.D., Vice President for Biological
      Programs, Nuclear Threat Initiative............................    36
    Thomas V. Inglesby, M.D., Deputy Director, Johns Hopkins Center
      for Civilian Biodefense Strategies.............................    38
    Thomas L. Milne, Executive Director, Governance Support Team,
      National Association of County and City Health Officials
      (NACCHO).......................................................    40

                         Alphabetical List of Witnesses

    Hamburg, Margaret A., M.D.:
        Testimony....................................................    36
        Prepared statement with an attachment........................    54
    Inglesby, Thomas V., M.D.:
        Testimony....................................................    38
        Prepared statement...........................................    67
    Milne, Thomas L.:
        Testimony....................................................    40
        Prepared statement...........................................    74
    Thompson, Hon. Tommy G.:
        Testimony....................................................    10
        Prepared statement...........................................    41

                                    Appendix

    Article entitled ``Public Health Preparedness,'' Science
      magazine, February 22, 2002, submitted by Dr. Hamburg..........    66
    Chart entitled ``Bioterrorism Funding for Selected HHS Agencies''
      (submitted by Sen. Cleland)....................................    83
    Chart entitled ``Federal Bioterrorism Preparedness and Response
      Activities'' (submitted by Senator Cleland)....................    84
    Chart entitled ``Sources of Formal Authorities and
      Responsibilities of Various Federal Agencies In the Event of
      Bioterrorism--Executive Documents'' (submitted by Senator
      Cleland).......................................................    85
    Chart entitled ``Sources of Formal Authorities and
      Responsibilities of Various Federal Agencies In the Event of
      Bioterrorism--Statutory Authorites'' (submitted by Senator
      Cleland).......................................................    86

    Questions for the Record and Responses from:
        Hon. Thompson................................................    87
        Dr. Hamburg..................................................    91
        Dr. Inglesby.................................................    95
        Mr. Milne....................................................    99

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

                                  ----------

                            THURSDAY, APRIL 18, 2002

                                           U.S. Senate,
                             Committee on Governmental Affairs,
                                                        Washington, DC.
        The Committee met, pursuant to notice, at 9:35 a.m., in
    room SD-342, Dirksen Senate Office Building, Hon. Joseph I.
    Lieberman, Chairman of the Committee, presiding.
        Present: Senators Lieberman, Cleland, Akaka, Dayton,
    Carper, Collins, and Bunning.

                OPENING STATEMENT OF CHAIRMAN LIEBERMAN

        Chairman Lieberman. The hearing will come to order. Good
    morning and thanks to all of you for being here.
        Today, the Committee on Governmental Affairs examines the
    Public Health System's readiness for a terrorist attack
    involving biological, chemical, or radiological weapons. This
    hearing, which was specifically requested by our friend and
    colleague, Senator Cleland of Georgia, follows up on a session
    the Committee held last October that exposed a public health
    system underprepared to respond to a series of biological
    attacks that had occurred in the form of anthrax sent through
    the U.S. mail.
        I thank Senator Cleland particularly because he has led the
    way on so many of these issues. You arrived just in time to
    hear me praising you. It could not be better timing or more
    well deserved, thanking you for your thoughtful and impassioned
    work to increase the security of the American people at home.
    In particular, I want to recognize Senator Cleland's efforts to
    strengthen our country's ability to respond to biological
    weapons by crafting legislation that would establish a much
    needed central coordinating office at the Centers for Disease
    Control.
        Senator Cleland will, I am pleased to say, assume the
    chairmanship of the hearing as we go forward and I must leave
    to go on to other commitments.
        Let me go back to the anthrax attacks of last fall. Five
    Americans lost their lives because of their exposure to anthrax
    last fall. It was a vicious, fast-acting terror weapon that we
    knew very little about. But our ignorance of anthrax and how it
    works was compounded by bureaucratic labyrinths that prevented
    critical information from getting to those who might have
    helped save lives. Fortunately, the anthrax attack, deadly as
    it was, was on a relatively small scale. Had it been a wider
    attack, I think it is clear that the public health system would
    have been quickly overwhelmed.
        Today, we are gathered here to ask for a 6-month assessment
    of the Federal Government's ability to prepare for and respond
    to a future attack, and specifically for an update on the
    coordination between public health and law enforcement
    agencies, which ran afoul of each other in the midst of last
    year's terror.
        We are very pleased and grateful to have Secretary of
    Health and Human Services Tommy Thompson return as a witness
    today to speak about the progress his Department has made on
    these fronts.
        The first thing that we all learned about a biological or
    chemical attack is that it differs from a conventional
    terrorist attack and, therefore, requires a different response.
    A biological attack would probably follow a more insidious
    course. It is a stealth attack, in effect, that might make
    itself known slowly and perhaps only intermittently and in
    places that are disparate, such as doctors' offices, health
    care clinics, or hospital emergency rooms.
        As an oversight committee, it is our duty to ask if the
    government is prepared to protect American lives should the
    unthinkable occur, and the answer today, I believe, is that
    despite some promising progress, Americans are still at risk.
    Ten major agencies and dozens of bureaus, including the Defense
    Department and the intelligence agencies, are responsible for
    threat assessments, surveillance of disease outbreaks, the
    protection of food and water supplies, developing and
    stockpiling vaccines, and assisting State and local governments
    in planning, training, and responding to attack. Secretary
    Thompson's Department alone has six different agencies involved
    in response preparation to bioterrorism and chemical terrorism.
        The problem is that each of these dozens of offices, as is
    commonly the case throughout government, communicates with its
    own particular constituency but too frequently fails to speak
    and coordinate with other agencies involved in the same
    undertakings. I must say that if we have learned anything from
    our examination of homeland security in this Committee over the
    last 6 months, it is that poor communication and coordination
    among Federal agencies and between Federal, State, and local
    governments is clearly one of the greatest impediments to
    adequately protecting the public.
        I know that Secretary Thompson and the administration are
    aware of the daunting task before them. Since October, the
    administration has set aside over $1 billion to help States
    respond to public health emergencies resulting from terrorism
    and it has requested an additional $4.3 billion in the fiscal
    year 2003 budget, which is an increase of 45 percent over the
    current fiscal year, and all of it to prevent, identify, and
    respond to bioterrorist attacks.
        Last fall, Secretary Thompson appointed a special assistant
    to coordinate the agency's bioterrorism programs and HHS has
    developed a central command center where it can monitor
    information about bioterrorist attacks and respond accordingly.
        As I understand it, the administration also plans to expand
    CDC's health alert network, which would connect every county
    health system in America to CDC through the Internet, and half-
    a-billion dollars is slated for a program to help local
    hospitals.
        Despite these steps, the Federal Government, I conclude, is
    still a long way from where we need it to be, and in the longer
    term, we need to build a more robust public health system with
    aggressive health surveillance programs to detect the onset of
    illnesses, and we need better coordination and better support
    for State and local governments and their health care systems.
        So it is up to us. Only the Federal Government can ensure
    that the necessary programs and structures are in place to
    protect the American people from a biological, chemical, or
    radiological attack and we must work together, Executive
    Branch, Legislative Branch, and private sector and nonprofit
    private sector. We must work together to make sure we are
    operating from a position of strength and unity to fulfill our
    duty in this new post-September 11 age to protect the American
    people.
        Senator Collins.

                  OPENING STATEMENT OF SENATOR COLLINS

        Senator Collins. Thank you, Mr. Chairman, and thank you for
    calling this hearing to look at the progress that has been made
    since the anthrax attacks last fall and to assess what remains
    to be done to strengthen the Public Health System's ability to
    prepare for and respond to a biological or chemical attack.
        The tragic events of last September and October were a
    powerful reminder of just how vulnerable our Nation is to
    terrorism and how woefully underprepared much of our public
    health system was to respond to such an attack. Moreover, the
    attacks have heightened our fears that we could face an even
    more devastating attack in the future, including the
    possibility of a mass casualty attack with a deadly biological
    agent like smallpox.
        Bioterrorism is unlike any other form of terrorism. While
    explosions or chemical attacks cause immediate and visual
    casualties, the intentional release of a biological agent, such
    as smallpox, may at first go unnoticed and, thus, could be far
    more insidious. It causes a ripple effect that unfolds over the
    course of days or weeks. If not contained, it can spread to
    others who were not initially exposed, causing a major epidemic
    and posing a real threat to the survival of our population.
        The long-term threat of biological weapons is very real.
    Moreover, future advances in technology will not only make
    these weapons more dangerous, but also make them more
    accessible and affordable to those who would do us harm. Tragic
    as they were, the anthrax attacks in the fall were, in effect,
    a dress rehearsal for what we may very well face in the future.
        It is, therefore, extremely important that we take a close
    look at what happened last fall, as we are doing in this
    morning's hearing, and analyze dispassionately what went well
    and what did not.
        The hearing held by this Committee 6 months ago in the wake
    of the terrorist attacks revealed our Nation's lack of
    preparedness to cope with an attack using a biological or
    chemical weapon. Witnesses identified a number of weaknesses as
    well as a number of factors that are critical to the rapid
    detection and response to such an attack. I remember the
    testimony that we had about the alert public health lab in
    Florida that identified that the first exposure was, in fact,
    anthrax. Had that sample been sent elsewhere, who knows whether
    the initial case would have been identified as anthrax as
    quickly as it was.
        Witnesses told us that we need alert health providers who
    are trained to recognize the symptoms and signs of a biological
    attack, as well as trained to treat such diseases. We need a
    core of well trained public health professionals engaged in
    disease surveillance. We need an adequate supply of necessary
    drugs and vaccines, something that I know that the Secretary
    has taken considerable steps to bring about. We need seamless
    coordination and communication, as the Chairman indicated, in
    order to avoid the problems that we saw last fall. We need a
    network of up-to-date public laboratories. And we need strong
    safeguards to protect our Nation's food and water supplies.
        In addition to strengthening our Federal response, we must
    remember those who are going to be the first responders, our
    emergency medical personnel, our fire fighters, our police
    officers, and our labs throughout the country. Those are the
    people who stand on the first line of defense in the event of
    any major biological or chemical attack. We must ensure that
    they have the capacity to identify the signs of an attack and
    the resources to be prepared.
        I am, therefore, pleased to have helped to draft the
    Bioterrorism Preparedness Act, which passed the Senate last
    December and is now in conference. This bill takes major steps
    not only to strengthen our Federal response, but to provide
    additional substantial new funding to States, local
    governments, and hospitals.
        Mr. Chairman, our world was forever changed on September
    11, and unfortunately, the threats of terrorist attacks that
    were once unimaginable are today horrifyingly real. But just as
    the terrorist attacks of September and October have caused us
    great concern and considerable pain, they have also
    strengthened our resolve. I am confident that we are making
    progress and I look forward to hearing the Secretary's
    testimony this morning and I thank you for holding this
    important hearing.
        Chairman Lieberman. Thank you very much, Senator Collins.
        Senator Cleland, thank you again for your leadership in
    bringing this hearing together.

                  OPENING STATEMENT OF SENATOR CLELAND

        Senator Cleland. Thank you very much, Mr. Chairman. May I
    just say that I first got into this whole issue of biological
    and chemical warfare about 3 years ago in hearing former
    Secretary of Defense James Schlesinger talk about the new
    threats we faced. As a fellow member of the Armed Services
    Committee, you might have been there, too.
        It struck me--I shall never forget what he said. We were
    discussing nuclear weapons and the scientific challenge that
    produced. You had to have some skill, you had to have some
    talented people, and you had to have a delivery system,
    probably a missile system. But Jim Schlesinger said that, in
    terms of biological and chemical weapons, he said you can make
    a biological weapon if you can brew beer and you can make a
    chemical weapon if you can make fertilizer.
        That really shocked me. It put me on notice that, in many
    ways, for terrorists particularly, working off of a low-tech
    agenda, that the biological and chemical attack was in many
    ways the poor man's atom bomb, the poor man's weapon of mass
    destruction. And so I became concerned that the country was not
    quite adequately prepared to deal with this, in a sense,
    stealth or under-the-radar attack.
        We went through September 11 of last year and we had the
    attack on the World Trade Center and the Pentagon. We scrambled
    the jets. Now we are prepared militarily in a second's notice
    to scramble more jets. Secretary of Defense Rumsfeld has
    created a four-star command looking after the continental
    United States, Mexico, and Canada, stationed near the NORAD
    headquarters in Colorado. We have nerve centers in the Pentagon
    and the situation room in the White House that addresses itself
    to an instantaneous response to literally a military or
    terrorist attack.
        My problem is that I do not think we are that well prepared
    in terms of a biological or a chemical attack and I have been
    searching for a strategy, searching for the elements of quick
    response, coordination, cooperation, and communication in our
    strategy for defending our homeland in case of a biological or
    chemical attack.
        I would like to thank Secretary Tommy Thompson for being
    here, a friend, and a great public servant.
        The state of our public health preparedness for terrorism,
    I think, is lacking in many ways. We are a country looking for
    a strategy in how to deal with this issue. I am grateful to
    you, Mr. Chairman and Senator Thompson, for calling this
    hearing to assess the progress we have made to date to ensure
    that our commitment to implementing a strong homeland defense
    against bioterrorism does not wane.
        Even as the anthrax crisis of last fall recedes, and
    Senator Collins mentioned a health agency in Florida that found
    that it was anthrax down there in Boca Raton. The interesting
    story about that is that the doctor reported it to the public
    health entity in the State of Florida, the State public health
    operation in Jacksonville, which had just had an employee get
    training at the CDC on anthrax. They forwarded the spores to
    the CDC and at 3:30 a.m., the CDC said, it is anthrax.
        So in many ways, that kicked off this whole discussion of
    how does all this work? How does the public health sector work?
    What is the role of the CDC? What is the role of HHS? What is
    the role of the FBI, and the law enforcement agencies?
        In so many ways, our homeland and its defense as an issue
    looms as ominously as ever over our heads. I am pleased to
    continue our ongoing dialogue with Secretary Thompson on the
    matter of bioterrorism preparedness. I, and I think I speak for
    all of my colleagues, as well, would like to express our
    gratitude to you and to your entire team at HHS for your
    efforts to guide our Nation through a very, very difficult
    time.
        At the outset, I would just like to express my strong
    conviction that combatting the threat of bioterrorism will
    demand the commitment and full cooperation of us all, of every
    relevant resource. Congress and the Executive Branch must work
    together toward our common goal, and let me signal to you this
    morning, Mr. Secretary, my unequivocal desire to work with you
    and the Department of Health and Human Services and the
    administration and the Office of Homeland Security and other
    relevant Federal, State, and local authorities to build a
    strong national defense and a strategy to deal with
    bioterrorism.
        I would like to commend you and the administration for a
    number of steps you have already taken. In the next fiscal
    year, the administration has proposed dedicating an
    unprecedented $4.3 billion to HHS's bioterrorism initiative, a
    45-percent increase. Mr. Secretary, you have named Dr. D.A.
    Henderson, the pioneering former Centers for Disease Control
    and Prevention official who led the campaign to eradicate
    smallpox, an eminently qualified expert on bioterrorism, to
    head the new Office of Public Health Preparedness. We are
    looking forward to seeing how that office relates to the other
    entities involved in bioterrorism. I think the existence of a
    coordinating office such as this one is actually essential as a
    step forward in coordinating the bioterrorism response.
        I am particularly interested this morning in hearing more
    from you, Mr. Secretary, on three issues I would like to
    explore in depth within the larger subject of our discussion,
    which bear strongly on our Nation's preparedness to deal with
    the public health consequences of terrorism involving weapons
    of mass destruction.
        First, I believe we in the Congress have got to provide you
    and your Department with whatever resources you need and think
    are necessary to protect our country from bioterrorism. We made
    a good start when we finalized the budget for the current
    fiscal year by increasing bioterrorism funds in HHS ten-fold. I
    must express my concurrence with Senator Frist's guarded
    assessment, however, that while that is ``enough to take us
    from an unprepared state to a more prepared state,'' we cannot
    yet say that the public health sector is actually adequately
    prepared to deal with the public health implications of
    terrorism with weapons of mass destruction.
        We must keep in mind that we started this race to catch up
    a lagging public health infrastructure just 3 years ago, and
    then from a virtual standstill. I think it is, therefore, worth
    asking whether the administration's proposed increase for
    bioterrorism defense, significant though it is, is actually
    sufficient. The magnitude of the threat and the potentially
    catastrophic consequences of underestimating our needs demand
    that we ask that question, and I will detail several specific
    resourcing concerns when we reach the question and answer
    period.
        Second, Mr. Secretary, I look forward to receiving the
    specific details of HHS's One Department initiative. As I
    understand it, under the initiative, the Department would
    consolidate each of the public affairs and legislative liaison
    offices of all the agencies within HHS into one office for each
    function under the Secretary. I certainly share a desire to
    address the communication challenge, particularly in terms of,
    shall we say, an attack when confusion reigns.
        I remember one old sergeant down at Fort Benning told me
    that war was the most socially disorganized human endeavor. So
    when one is under attack, the ability to speak clearly in
    communications, we put a premium on that. It can actually
    lessen the fear and lessen the terror.
        I do have concerns that this proposal, though, while
    potentially improving the consistency of communication, might
    have at the same time the undesirable and unintended effect of
    actually slowing the movement of information from public health
    experts in the Federal Government to their State and local
    counterparts, and so I am eager to hear more details from you.
        Finally, I believe that today, we have got to address the
    coordination and communication failures that encumbered the
    interaction between public health officials and their law
    enforcement partners in last fall's anthrax crisis. We are not
    looking here for a witch hunt. We are just looking to figure
    out exactly where we are and move forward.
        My interest this morning is not in placing blame for past
    failures or in revisiting old ground, but we cannot afford to
    suffer again the profound disconnect between public health and
    law enforcement that we saw last fall. I would very much like
    to hear from you, Mr. Secretary, about what has been done since
    then to strengthen protocols of coordination and cooperation
    and communication between public health entities and law
    enforcement, and I proposed some legislation last year to deal
    with that and we can get into that.
        May I say, in addition, I would just like to offer for your
    consideration and input, Mr. Secretary, a proposal I introduced
    in the Senate last week to address what I see as an urgent need
    for a single center in the Federal Government whose sole
    mandate is to counter the threat of domestic terrorism, in
    other words, help the country prepare and then help the country
    respond. This legislation would create a dedicated National
    Center for Bioterrorism Preparedness and Response in the CDC.
        Why the CDC? It has got 8,000 employees and they are
    located in 39 different countries around the world. It probably
    is the finest single public health network in the world and
    certainly is a great asset to this Nation, and it operates
    based on several centers that are within CDC. So much of CDC's
    time now is taken up with planning, executing, and helping to
    respond to bioterrorism, somewhere around, I think, 40 percent
    of their time now, except there is no center there to focus
    their energies and to actually help focus monies and to
    actually help us all understand how the monies are being spent
    and see if they are being spent wisely.
        In closing, Mr. Secretary, I would like to convey to you my
    empathy for the difficult task before you. I used to be head of
    the Veterans' Administration under President Carter. I have sat
    in your seat many times, not with your specific
    responsibilities, but I understand the challenges that you face
    and we look forward to hearing from you this morning. Thank you
    very much for being here.
        Chairman Lieberman. Thank you, Senator Cleland. Thanks very
    much.
        Senator Bunning.

                  OPENING STATEMENT OF SENATOR BUNNING

        Senator Bunning. Thank you, Mr. Chairman, and welcome,
    Secretary Thompson and all other witnesses today.
        The anthrax attacks on the Capitol last year gave us a
    firsthand experience in dealing with a bioterrorist attack and
    we got to see exactly where our weaknesses were. To put it
    bluntly, we have a long way to go in ensuring that our Nation
    can respond to a large-scale biological or chemical attack. We
    need better communications, as everyone has said, between the
    Federal, State, and local governments. We need more training
    for first responders and we need to be able to swiftly identify
    the illnesses that are the cause of the attack.
        One of the most important things we need during a crisis is
    honesty. Those responding to a terrorist attack need to be able
    to admit they do not know everything. The American people are
    very savvy and the Federal Government will lose all credibility
    if conflicting and inaccurate information is given. During a
    public health crisis, it is critical that people have faith in
    their government that the government is being straight with
    them.
        The President has made preparing for a biological attack a
    very high priority. As you well know, and it has been stated,
    in his 2003 budget, the President has requested $5.9 billion,
    of which $1 billion is already up front, to prepare for such an
    attack. This money would help State and local governments
    prepare, conduct more research and development, enhance the
    safety of our food supply, and improve our Federal response
    capabilities.
        All of these are extremely important and I hope that
    sometime in the near future, we will begin to feel comfortable
    that our responders are trained, our hospitals are equipped,
    and that we can handle any attack that might come.
        I want to thank our witnesses for being here today and I
    look forward to gaining their perspective on this important
    issue. Thank you, Mr. Chairman.
        Chairman Lieberman. Thanks, Senator Bunning.
        Senator Akaka of Hawaii has also been very active in a
    leadership role in regard to the threat of bioterrorism and I
    am happy to call on him.

                   OPENING STATEMENT OF SENATOR AKAKA

        Senator Akaka. Thank you very much, Mr. Chairman. Thank you
    for holding today's hearing on an issue that has occupied the
    Committee's attention well before the terrorist attacks on
    September 11 and the anthrax mailings last fall.
        As Chairman of the Subcommittee on International Security,
    Proliferation, and Federal Services, I want you to know that I
    appreciate the work we have done together in this Committee on
    Federal efforts to prepare for acts of terrorism. I also wish
    to thank the Secretary for joining us today. I read your
    statement with interest, and I want to commend you for moving
    so quickly in enhancing your efforts and facing the issue of
    biological and chemical acts of terrorism. As you said, we have
    lots to do, and we will do it. What I am saying now, we will
    try to do it together.
        Secretary Thompson. Thank you.
        Senator Akaka. Thank you, Mr. Secretary.
        A clear refrain from the hearings we have held was that a
    cultural divide existed between the law enforcement and public
    health communities. It was evident then that the United States
    lacked a cohesive strategy to respond to terrorist attacks
    involving weapons of mass destruction. The following points
    were apparent from our joint hearing in October.
        Local first responders lack the resources to respond
    quickly. Emergency responders must be able to communicate and
    coordinate seamlessly in the event of terrorist attacks with
    WMD. Local public health officials lack the capability to
    detect and identify harmful biological agents rapidly.
        At the October hearing, Secretary Thompson and I agreed
    that current methods were not adequate to deliver continuous
    monitoring of the air, water, and food supplies of the United
    States. We are not effectively coordinating biological agent
    detection research at Federal agencies and academic and
    industrial laboratories. The Federal Government is not
    unprepared to deal with WMD terrorism, but preparedness levels
    are not uniform across the United States.
        Much deserved attention has been paid to our crumbling
    public health sector. However, efforts to improve our public
    health infrastructure will not automatically trickle down to
    the medical community. Adequate WMD terrorism training of
    health care professionals has been hindered by a lack of
    economic incentives for hospitals and clinics. Local and
    community hospitals should have the best training and
    information in order to protect and treat Americans.
        I recently introduced legislation, Mr. Chairman, to support
    the development of technologies to minimize the impact of
    bioterrorism by alerting authorities and medical personnel to a
    biological threat before symptoms occur. Another bill I
    introduced will use existing capabilities in the national
    disaster medical system to strengthen bioterrorism preparedness
    and to expand WMD emergency training opportunities for health
    care professionals. This legislation will continue the dual
    national goals of advanced biological agent detection
    technologies and improved emergency medical response training.
        Again, I want to welcome the Secretary to the panel and our
    other witnesses today for our hearing and I look forward to
    learning what the Department of Health and Human Services has
    done in its enhancement in the past 6 months to improve our
    public health and professional medical response to potential
    terrorist attacks with weapons of mass destruction.
        Thank you very much, Mr. Chairman.
        Chairman Lieberman. Thank you, Senator Akaka.
        Senator Dayton, would you like to make an opening
    statement?
        Senator Dayton. Mr. Chairman, thank you very much. I would
    not. I would just like to hear from the witness and I would
    like to thank him for his continuing excellent service to our
    Nation following up on his distinguished service as governor.
        Chairman Lieberman. Thank you, Senator Dayton.
        Secretary Thompson, on behalf of all of us, thanks for the
    job you are doing, thanks for being here, and we now look
    forward to your testimony.

        TESTIMONY OF HON. TOMMY G. THOMPSON,\1\ SECRETARY, U.S.
     DEPARTMENT OF HEALTH AND HUMAN SERVICES, ACCOMPANIED BY JERRY
                                 HAUER

        Secretary Thompson. Thank you very much, Chairman
    Lieberman. It is an honor to be in front of you. It is a real
    honor for me to get an opportunity to tell this Committee what
    the Department of Health and Human Services is doing and has
    done and will continue to do. Senator Thompson, who is not
    here, Senator Collins, Senator Cleland, Senator Akaka, Senator
    Dayton, and Senator Bunning, it is my privilege to be in front
    of you today and thank you so very much for inviting me.
    ---------------------------------------------------------------------------
        \1\ The prepared statement of Secretary Thompson appears in the
    Appendix on page 41.
    ---------------------------------------------------------------------------
        All of you have been staunch supporters of our efforts on
    the homefront in this war. We share a commitment and a passion
    to ensuring that Americans can live their lives in safety and
    security. Let me begin by thanking you so very much for your
    dedication and your patriotism.
        Building America's preparedness for a bioterrorism attack
    is absolutely of paramount importance to the security of our
    country. Should an attack occur, the President is absolutely
    committed to making sure that we are ready to handle it quickly
    and successfully. Over the past 6 months, the President has put
    forth bold plans to build America's homeland security. We
    appreciate the support of Congress for the administration's
    supplemental request last year and we appreciate your continued
    support as we work out a 2003 budget.
        As you know, the Department of Health and Human Services
    and my office have been working at breakneck speed to build our
    bioterrorism preparedness, particularly since the attacks of
    September 11. This has included everything from enhancing our
    pharmaceutical stockpiles to building a stronger public health
    infrastructure, which all of us have to admit was in disarray
    and now needs to be bolstered, built, and completed. The
    speeding up of research and to do medicine and diagnostic
    tools. We continue to get stronger each and every day and I am
    extremely proud, Mr. Chairman and Members, to be able to come
    to you today to report on the progress that we have made with
    your support.
        Today, I would like to update you on some of the measures
    that the Department of Health and Human Services has taken
    already to bolster our overall preparedness and our ability to
    respond. Let me begin with our efforts in strengthening the
    partnership between the Federal, the State, and the local
    governments. In short, we are building a much more cohesive
    public health system and doing so faster than many people
    thought possible.
        Within just 3 weeks after the President signed the
    supplemental appropriation on January 10, our Department,
    working almost around the clock, put together a program in
    structure for dispensing $1.1 billion to the States for public
    health system improvements. We are quite confident that no
    Federal program of similar size has been created so quickly or
    that money of this caliber was moved out of the Federal coffers
    so quickly after our legislation became law. But it is a sign
    of our commitment and our passion to build correctly, but build
    rapidly.
        By January 31, we gave States 20 percent of their share, 3
    weeks after the signing of the law, of the $1.1 billion program
    and asked them to get back to us by April 15, which was this
    week, a comprehensive plan for how they would spend the
    remaining 80 percent to be able to build a stronger, more
    unified public health system in their respective State. The
    vast majority of the States gave us the proposed plans. They
    came in this week. And the CDC and HRSA are beginning to review
    them. We have given about 12 States and territories a dozen
    extensions.
        The very infusion of this unprecedented level of money into
    States is going to force cooperation and the strengthening of
    our Nation's health system, and I would like to report that we
    are going to analyze and critique and get back to the States
    within 30 days all of the reports and give out the remaining 80
    percent of the money. That is how fast we are moving.
        States, counties, and communities, law enforcement,
    hospitals, and the medical community are all going to have to
    come together, and we are forcing them to develop that
    cohesive, comprehensive public health system that will be able
    to handle a bioterrorism event, and those efforts are going to
    be linked and coordinated with the Federal Government, and that
    is what the comprehensive plan is all about.
        And to further strengthen our public health system, the
    budget for 2003 provides for another $518 million specifically
    to build up hospital preparedness. We had $135 million in the
    supplemental bill that went out to hospitals under HRSA. Now we
    are requesting an additional $518 million to build upon that
    comprehensive, especially in the area of surge capacity for
    regional hospitals. We expect this money to be used to upgrade
    the capacity of hospitals, outpatient facilities, emergency
    medical service systems, as well as poison control centers to
    care for victims of bioterrorism.
        In addition, the CDC is going to provide support for a
    series of exercises to train public health and hospital workers
    on how to treat and be able to control bioterrorism outbreaks
    together. So, as you can see, one of our highest priorities
    right now is building a stronger and a much more coordinated
    public health system that works closely together in a time of
    crisis. And again, we are moving as fast as possible and
    getting stronger as each day passes.
        A crucial part of bioterrorism preparedness is the
    development of vaccines and the maintenance of the National
    Pharmaceutical Stockpile. We are purchasing enough antibiotics
    to treat up to 20 million individuals for exposure to anthrax.
    We are purchasing sufficient smallpox--and I would like to
    point out, when I took over, there was only an order for 40
    million doses of smallpox vaccine to be delivered either in
    2004 or in 2005. Since I took over, we have increased that 40
    to 54 million from one company, 155 million from another
    company, and we have 15.4 million in our stockpile which can be
    distilled down five-to-one for 77 million, plus we just picked
    up an additional 85 million doses from Aventis Pasteur, which
    will give us well over 286 million doses of vaccine, enough for
    every man, woman, and child, by October of this year. Nobody
    thought it could be done.
        We are purchasing also additional push packages, going from
    400 tons of medical equipment in antibiotics and other
    medicines, from 400 tons to 600 tons, from eight push packages,
    which are now strategically located around the United States
    and in Hawaii, to 12. So we will have much more medicine
    supplies available and be able to move it. Our plan is to be
    able to move it within 12 hours, but we were able to move
    within 7 hours to the City of New York on September 11. That is
    how fast we are able to respond.
        We found that one of the problems was we can move it faster
    than the local units of government can handle it once it
    reaches the tarmac at a particular community. So we are now, in
    our comprehensive planning, we are finding ways in how we can
    bolster that so not only can we move it rapidly, but the local
    individuals will be able to dispense and be able to break it
    down faster to get it to the hospitals and to the areas where
    it is needed.
        We are also taking aggressive steps to improve laboratory
    security and to be able to protect our food supply that you,
    Senator, and I have discussed many times, and accelerate the
    research necessary.
        While we are doing a great deal right now to strengthen our
    infrastructure, we have also made it clear that improving our
    bioterrorism readiness will be an ongoing endeavor. That is why
    the President has put forth a bioterrorism budget for HHS of
    $4.3 billion, which is a 45 percent increase.
        Mr. Chairman, this is the largest one-time investment in
    the American public health system ever. We are absolutely doing
    what it takes to make America secure and we are working to
    ensure that our efforts are coordinated from the highest levels
    of the Federal Government to the most local levels of health
    care delivery.
        And along with the new monies I just mentioned for
    hospitals, the President's budget provides $1.7 billion for the
    National Institutes of Health for research into new vaccines
    and diagnostics. We are ready for smallpox, but we want to go
    to the next level for anthrax. We want to develop a new vaccine
    that is better than the one that is currently being used. We
    are also looking for ways for plague, botulism, the hemorrhagic
    fever viruses, and tularemia. The FDA is also going to see an
    increase for its review of vaccines and diagnostics and the CDC
    will see increases for the security of its facilities, as well
    as updating their badly needed lab capacity.
        Nine-hundred-and-forty million dollars for State and local
    organizations to continue their laboratory capacity, increase
    epidemiological expertise. We want to get an epidemiologist in
    every community that has a county of over 150,000. Provide for
    better electronic communication and more distance learning. And
    support expanded focus on cooperative training between public
    health agencies and local hospitals. This includes funding for
    the Laboratory Response Network, which we have set up, which
    improves a system now of over 80 public health laboratories
    specifically. And to be able to develop for identifying
    pathogens that could be used for bioterrorism.
        We are working to connect every major county and
    metropolitan region with the Health Alert Network. We are at 68
    percent capacity right now. We think by the end of this year,
    with this new money, we can go from 68 percent to 90 percent of
    the population in the United States to be covered by the Health
    Alert Network.
        Five-hundred-and-eighteen million dollars under the
    Hospital Preparedness Program to support outbreak response and
    control. It includes funding for the training of public health
    and hospital staffs. The increased focus on local and State
    preparedness serves to provide the funding where it best serves
    the interests of this great Nation.
        One-point-seven billion dollars for research. The NIH is
    researching for better anthrax, as I indicated, plague, the
    hemorrhagic fever viruses, and so on.
        Ninety-eight million dollars, and thanks to you, all of
    you, for supporting this, in order to keep our food supply. I
    have testified in front of this Committee and others that I am
    more worried about food pathogens right now because we only
    inspect less than one percent of the food coming into our
    Nation. We only have 125 food inspectors, ladies and gentlemen,
    for 175 ports of entry. It tells us that this is an area that
    we have to look at. We have been able now, because of your
    support, to be able to double the number of inspectors we have
    at FDA. Our budget proposal is going to support a substantial
    increase in this number of safety inspections for FDA-regulated
    products that are imported into this country.
        A-hundred-and-eighty-four million dollars to upgrade our
    Federal laboratory facilities and capabilities. This includes
    money for the completion of a second infectious disease
    laboratory, an environmental laboratory, an infectious disease
    bioterrorism laboratory in Fort Collins, one that they can only
    do research once in a while because of the decrepit conditions
    of that particular laboratory. I have pictures that I would
    like to show the Committee and you could see why it is badly
    needed for this particular laboratory.
        We are going to have an environmental toxicology lab and a
    communication and training facility in Atlanta. This funding
    will enable the CDC to handle the most highly infectious,
    Senator Cleland, and lethal pathogens in the world.
        We hope the Senate will continue to support the
    administration's effort to strengthen our public health system
    throughout the Nation. We need this partnership in a bipartisan
    way and I thank you for your past support.
        Here at HHS, we are strengthening our coordination, as
    well. When I first arrived a little more than a year ago, I
    began elevating the bioterrorism efforts into my office and
    found that there was nobody there when I came in that actually
    coordinated our activities. I named Scott Lillibridge, Dr.
    Lillibridge from CDC, as my special assistant on bioterrorism.
    This was the first time that bioterrorism had been given such
    attention at the highest levels of HHS.
        Since then, we now have created--I took one of my hearing
    rooms, my big conference room right across from the Secretary's
    office and I have turned that into the Office of Public Health
    Bioterrorism, which we are able to monitor things 24 hours a
    day, 7 days a week from all over the country. We are able to
    deploy personnel and medicines from there at a minute's notice,
    which has the task--this office has the task of coordinating
    and overseeing the bioterrorism preparedness and the response
    activities of all the various agencies within HHS.
        This office coordinates our efforts and makes sure that HHS
    is coordinated with also the other Federal departments, State
    and local governments, and other stakeholders. It also makes
    sure that our efforts are well executed.
        I have assembled a virtual bioterrorism dream team to staff
    this office. Dr. D.A. Henderson, an internationally acclaimed
    leader in public health, is the Director, and working side by
    side and also with me today is Jerry Hauer, a world renown
    emergency response expert who we were fortunate to get from New
    York City. Also on the team is retired Major General Dr. Philip
    Russell, one of the Nation's preeminent virologists, and Dr.
    Mike Asher, one of our Nation's leading laboratory experts.
        We also have strong relationships with our Federal
    counterparts, most notably homeland security. Tom Ridge and I
    have a very strong working and personal relationship going back
    to our days as governors. We and other teams have worked
    flawlessly together and I am very pleased with our working
    relationships also with Justice, the FBI, and the Department of
    Defense. In fact, the Department of Defense, with all their
    surgeon generals, were over this week in my Department and we
    were planning how we could interact their research and their
    medical teams with our medical teams. We work closely together
    and we share information effectively.
        The President is creating a strong and united team for
    defending our homeland and preparing for our response to an
    emergency.
        Mr. Chairman, you also requested that I mention a component
    of the President's management agenda that involves the
    consolidation efforts within the Department. In this budget, we
    are taking further steps to coordinate a variety of activities
    by consolidating our human resource, our building and
    facilities management functions, as well as public affairs and
    legislative affairs functions. These functions are very
    splintered right now, even within each agency.
        Mr. Chairman and Members, we have over 50 public relations
    departments. We have over 46 personnel departments. We have
    over 200 different computer systems. We have five bookkeeping
    systems. We have some of our computers that have 30-year-old
    software, and we are trying to bring this now into an
    integrated system, and that is what the management is all
    about.
        By consolidating and coordinating these operations, we will
    make sure that we are managing the taxpayers' dollars more
    efficiently and speaking to Congress and the American public in
    a clear, confident, accurate, honest, straightforward, and
    efficient manner.
        It is a common sense effort to make sure that when we
    communicate, it makes sense to the American people and the
    members of the House and the Senate. And in times of national
    emergency, clarity and accuracy are absolutely essential.
        In summary, our comprehensive effort shows that we are
    using all our resources at our disposal, from Federal agencies
    to States and localities, to build the strongest defense and
    response to bioterrorism. We are doing this quickly and
    smartly.
        Mr. Chairman, the Department of Health and Human Services
    is absolutely committed to working with you, the Members of
    this Committee, and Congress, as well as the other Federal
    agencies, the law enforcement communities, and our State and
    local public health partners to ensure the health and the
    medical well-being of all of our fellow Americans. We have made
    substantial progress to date in enhancing the Nation's
    capability to respond to biological or chemical acts of
    terrorism, but there is much more that we can do and will do to
    strengthen that response.
        In April 1861, as danger loomed before the Union, Abraham
    Lincoln issued a two-sentence directive to the then-Governor of
    Pennsylvania who had asked his opinion on what to do. He said,
    ``I think the necessity of being ready increases. Look to it.''
    It is in that spirit of swift, effective preparation for the
    unknown that we pursue our efforts. We will not rest and we
    will not falter until America is as prepared as it possibly can
    be.
        So I thank you for your support, Mr. Chairman and Members,
    very much for your time, as well, this morning. I would be
    pleased now to answer any questions you or Members of the
    Committee may have.
        Chairman Lieberman. Thanks very much, Secretary Thompson,
    for all you have done since last you were here. I think we all
    agree that we have come some way and we have got a ways to go
    to prepare our Nation to cope with chemical and terrorist
    attacks.
        If I asked you on a scale of one to ten, with ten being the
    highest level of preparedness, where would you say we are now
    as a Nation?
        Secretary Thompson. Once the money is out, I would say we
    are at six, going on seven.
        Chairman Lieberman. OK, so we have come some ways, but we
    have got to go some ways together yet.
        Secretary Thompson. Absolutely.
        Chairman Lieberman. I appreciate that, and that would be
    about my estimate if you asked me that question.
        Let me ask you about what you said about funding for
    hospitals to meet surge capacity. First, just for the record
    and for those who are listening, give us a little bit of a
    definition of what surge capacity means in this case.
        Secretary Thompson. Surge capacity means being able to take
    care of a minimum of 500 to 1,000 individuals immediately in
    case of an event such as a bioterrorism attack, such as
    anthrax, such as a chemical spill, such as a chemical terrorist
    attack, such as a nuclear attack.
        What we are doing in that regard, is asking the local
    health departments to meet with the State health departments
    and for the State medical system to develop a regional surge
    capacity right now, within their States, within their
    comprehensive plans. Then 2 days ago, I met with the surgeons
    general of the Department of Defense with regard to being able
    to incorporate--to be able to move in some of their mobile
    hospitals in case a more calamitous type of event takes place.
        So we want to integrate with the Department of Defense. We
    want to integrate with the State health departments so that we
    have surge capacities in every region of the country taken care
    of immediately. We want to make sure this year we are able to
    have surge capacities in every State, hopefully up to 500, and
    then, hopefully, up to 1,000 within the next 18 to 24 months.
        Chairman Lieberman. So that is the goal now, that within
    every State, we would have surge capacity up to 1,000 in every
    State?
        Secretary Thompson. Yes.
        Chairman Lieberman. Do we have----
        Secretary Thompson. Now, in the case of smallpox, that is
    different, if I might.
        Chairman Lieberman. Yes, please. That is exactly what I was
    thinking about.
        Secretary Thompson. With smallpox, what we would like to
    do--we would like to be able to have a large area to be able to
    quarantine. We may have a convention center. What we would do,
    is go in and inoculate--vaccinate the first responders, the
    medical personnel, and then those that would be sick, if, in
    fact, there was ever a smallpox outbreak. We would then have
    concentric circles around which we would vaccinate all those
    individuals, and then we would build a larger circle, and that
    is how it was worked out before. So, on chemical emergencies
    and smallpox, we have different ways and different
    opportunities as to how we would handle a surge capacity need.
        Chairman Lieberman. I think, as I hear you answer the
    question in that detail, that we have entered a surreal world
    which you and I would not have guessed we would be talking
    about a year ago, but it is where we are and I think it is very
    important that you do exactly what you are doing, which is to
    work through the scenarios that are worst case so we are ready
    for them.
        I hope that you will push both the administration and us in
    Congress in terms of funding. As significant as the additional
    funding requests by the President have been, if you decide that
    we need more in the years ahead, I just think this has to be
    now our No. 1 priority. We have to do whatever we can to meet
    it.
        Let me go on to a different area and that is the question
    about the weakness in our preparedness because of the lack of
    efficient mechanisms to communicate. One of our witnesses on
    the next panel in his written testimony points out that the
    Chief of Infectious Diseases at one of America's best hospitals
    said that in the midst of the anthrax crisis, he had to get his
    medical information from CNN. If we had another biological
    attack today, would those communications problems be any less
    severe, and if so, why?
        Secretary Thompson. We have right now 68 percent of the
    population covered by CDC's Health Alert Network. We are going
    to be able to expand that this year, up from 68 percent of the
    population being covered to 90 percent. My goal is to have
    every health department eventually hooked up to the Health
    Alert Network.
        CDC, and I do not want to question the individuals who are
    going to be following me in this testimony, but CDC puts out
    weekly reports to doctors. Their medical report went out on
    infectious diseases, especially on anthrax. We had weekly
    communications with doctors and State medical societies and
    hospitals and emergency workers hooked up with CDC. We are
    going to be able to expand that, especially with the additional
    money that is going out, and we are hopeful that we are going
    to be able to get this information very quickly.
        We are also going to be putting exercises out into the
    States. The health departments--part of the comprehensive plan
    is that the health departments have got to put an educational
    program put out by CDC into the hands of emergency workers and
    the emergency doctors, because that is where the problems would
    first arise. So we are already taking that into consideration.
    That is all part of the plans that the States put in.
        We have also divided the country up into different areas so
    that we can send experts in from CDC as well as from our
    medical assistance teams. We have about 82 medical assistance
    teams across America right now, about 7,000 personnel that we
    can send in within hours after an event.
        Chairman Lieberman. Is the communication network also going
    to make use of existing media, television, radio, and
    satellites?
        Secretary Thompson. That is one of the new buildings that
    is going to be built. Hopefully this year, the planning is
    going to start for a new communication building on the CDC
    campus. It is one of their next major capital expansions. Also,
    we have a website that every day has got new information on it
    through CDC and NIH and through the Department of Health and
    Human Services.
        Chairman Lieberman. Let me ask a final question before my
    time expires. As you know, during the anthrax crisis, there was
    some concern about exactly who was speaking for the
    administration, which led to some confusing and conflicting
    messages. In the event of an attack today, is it clear who
    would oversee communication with the public?
        Secretary Thompson. Yes. Right now, it would be our new
    Center for Bioterrorism, which is headed by Dr. D.A. Henderson
    and the doctors that I mentioned, in collaboration with CDC,
    NIH, and FDA.
        Chairman Lieberman. So that Dr. Henderson----
        Secretary Thompson. That would be the health thing.
        Chairman Lieberman. Right.
        Secretary Thompson. But then the White House would have
    their spokesperson and Homeland Security would have their
    spokesperson. But as relates to health information coming out
    of the Department, it would come out of our Center for
    Bioterrorism Preparedness.
        Chairman Lieberman. I presume, or let me ask, would there
    be coordination between the three, between that center,
    Governor Ridge, and the White House?
        Secretary Thompson. Yes. There is right now and I am sure
    there would continue to be. I cannot imagine--but as far as the
    Department, it is well coordinated right now and it would all
    go up through the Office of Public Health Preparedness.
        Chairman Lieberman. Thanks, Secretary Thompson.
        My time is up. I am going to yield to Senator Collins and I
    am going to give the gavel to Senator Cleland, as I have got to
    go off and participate in a debate on the floor. But I thank
    you very much and look forward to continuing to work with you.
        Secretary Thompson. Thank you very much, Mr. Chairman, for
    being here, and thank you for calling us.
        Chairman Lieberman. Senator Collins.
        Senator Collins. Thank you. Secretary Thompson, let me
    begin by thanking you for your strong and effective leadership.
    I think we are very fortunate to have you serving in this
    critical post at this very challenging time.
        I also want to thank you for again recognizing this morning
    the vulnerability of our Nation's food supply and the gaps in
    the regulatory framework. As you know from our previous
    discussions, back in 1998, I chaired hearings in the Permanent
    Subcommittee on Investigations that looked at the safety of
    imported foods. We did an in-depth investigation that revealed
    the statistic that you quoted this morning, that fewer than 1
    percent of imported food shipments are inspected, and we also
    found that the system was very easily circumvented by
    unscrupulous shippers.
        For example, tainted food that was checked at the border
    and inspected and rejected often was reshipped into the United
    States through another port. There was port shopping because
    the food was not required to be destroyed, nor was it clearly
    marked as rejected.
        That gives me great concern, because if the system was that
    easily circumvented by an unscrupulous shipper, think what a
    concerted, sophisticated terrorist network could do.
        So I am very pleased that there are additional inspectors
    on the way. I understand that the FDA intends to hire an
    additional 670 employees, which will include inspectors,
    scientists, and compliance officers. Given this significant
    increase in the number of inspectors, do you have a goal for
    how many inspections will be performed? There are a lot of
    other steps that need to be taken that are included in the
    legislation that has passed the Senate, but do you have a goal
    for increasing the number of inspections?
        Secretary Thompson. We do not have a goal, Senator. We are
    going to address that when we get all our inspectors trained.
    We also want new equipment because we have a very antiquated
    system right now. You bring food in. It may be tainted. It has
    to be taken off of a truck or off the airplane, then it has got
    to be sent to a lab, maybe in Kansas, and then the shipment has
    to be held, impounded until we get the lab analysis back. We
    are trying to make sure that we have faster and better lab
    analysis at the place that the food is taken off, to check it
    and make sure it is not tainted.
        We also, of course, as you know, support your language in
    the legislation. It is very powerful language as far as
    shipments coming into ports. We support you for your leadership
    on that.
        The conference committee is working on this particular bill
    right now. There are a lot of good things in there. We want to
    be able to reject food at the port of entry, send it back. We
    want to be able to tell a company or an individual that has
    sent in tainted food before, prevent them from shipping again.
    We want to be able to track back where this food is coming
    from.
        All of these provisions are in the legislation. We are
    hopeful that the conferees will be able to reach an agreement
    and get it to us because we badly need those tools.
        Senator Collins. I am very pleased to hear you endorse
    those provisions, which I worked very hard to have included in
    the bioterrorism bill. They have been subject to criticism by
    some. I hope we can hold the line because I believe they are
    absolutely essential if we are going to improve the safety of
    imported food and close what I think is a real gap that makes
    us extremely vulnerable.
        I want to follow up on an issue that Senator Lieberman
    raised. One of the major criticisms of our handling of the
    anthrax attacks involved the problems of communication and
    coordination. Obviously, we need to do everything we can to
    improve communication among the various levels of government as
    well as providing prompt and accurate information to help
    professionals and hospitals. I, too, was struck by the
    statement in the written testimony of the witness to come, who
    is Chief of Infectious Diseases at one of our Nation's best
    hospitals, and yet he said that he learned a lot of the medical
    information from CNN.
        Is part of the rationale behind the consolidation plan that
    you have outlined today intended to improve the flow of
    information and better ensure health care professionals are
    receiving consistent, accurate, and clear information?
        Secretary Thompson. The consolidation would not have much
    of an impact on that because the information going out to the
    emergency wards, going out to departments of health, and so on,
    for medical personnel comes from CDC. That will continue. It
    has to come from CDC because they are the experts and they are
    the ones who get the information. It will be better coordinated
    and it will be faster and better. But right now, we want to
    make sure we get the Health Alert Network up.
        What we are talking about in consolidation is to make HHS
    more effective. We have over 50 public affairs departments,
    divisions in the Department of Health and Human Services and it
    is impossible to get a coordinated and correct dissemination of
    the information that is necessary to the public out properly.
    We want this to flow up in collaboration with CDC, NIH, FDA,
    through the Office of Public Health Preparedness, which is
    headed by Dr. D.A. Henderson, so that we are able to make sure
    that it is correct, that it is straight, and is fast and gets
    out there.
        But as far as the medical information, that will come
    through the Health Alert Network. It will come on the website
    at CDC. It will come also from the direct communications from
    the laboratories. We have a communications system set up with
    80 laboratories across America, connected with CDC. All of
    these things will still continue out of CDC.
        Senator Collins. Thank you. My related question is actually
    a suggestion that results from a conversation that I had
    recently with medical director of the Anthem Blue Cross/Blue
    Shield insurance company. He pointed out to me that Blue Cross/
    Blue Shield has electronic links and E-mails to virtually every
    doctor's office and hospital in the United States, and he
    suggests that in the event of an emergency, it, too, might be a
    network that the Department could use to disseminate
    information.
        I want to pass that on to you and I was interested to know
    whether there are any discussions with Blue Cross/Blue Shield
    or other insurers that might have the infrastructure that
    perhaps the Federal Government lacks at this point.
        Secretary Thompson. Absolutely. We are working on that
    right now. Jerry Hauer has met with the American Association of
    Health Plans, has met with Blue Cross/Blue Shield, how we can
    tap into their database. We are doing all these things. We also
    got the pharmaceutical companies, through all of their agents,
    distributing information to doctors' offices on various
    pathogens and how to discern various infectious diseases, such
    as anthrax poisoning. And so we are bringing all the private
    sectors we possibly can, using them for the dissemination of
    information across America to doctors.
        In our plans, we are also going to be setting up
    information and evaluations in emergency wards across America.
    These are going to be put out by CDC through the State health
    departments so that we get this information into the emergency
    wards of our hospitals so that they will be able to be better
    educated, be able to discern more quickly anything that might
    come up. Then they would report that through the Health Alert
    Network to CDC. They would report it to the laboratories. Those
    laboratories are connected with CDC and it would be almost
    instantaneous.
        Senator Collins. Thank you, Mr. Secretary.
        Senator Cleland [presiding]. Senator Carper, do you have
    any comments, remarks, or questions?
        Senator Carper. I have some questions, but I do not want to
    go out of line. I think others were here before me.
        Senator Cleland. Senator Bunning, do you have any comments
    or questions?
        Senator Bunning. First off, a lot of attention seems to be
    focused on combatting bioterrorism in an urban setting.
    However, much of Kentucky, as you might suspect, is not urban.
    It is rural. How will combatting a bioterrorist attack in a
    rural setting be different than in a city? Is there anything
    you are doing to specifically help rural communities?
        Secretary Thompson. Absolutely. What we are requiring in
    our planning is we are requiring every State health department
    to work with the local health departments, to work with the
    local first responders, and the law enforcement officials to
    develop these comprehensive plans that are coming in.
        Kentucky has sent in their plan this week and their plan is
    going to be evaluated first by CDC. It is also going to be
    evaluated by HRSA for their hospitals. Then it goes to our
    Office of Public Health Preparedness and they will evaluate it
    and make suggestions, if needed, may approve it, may make
    suggestions. We have also sent out templates to all the health
    departments with regard to what are the best practices that we
    have been able to find so they have something to work from.
        In the case of Kentucky, they will be working on how to
    make sure that rural areas in Kentucky are properly prepared,
    working with the first responders, the public health
    departments, as well as everybody else, and we have sent out
    templates and we have got people from various States, both
    rural and urban, coming in to offer consultation to us with
    regard to these plans.
        Senator Bunning. I understand that, Mr. Secretary, but as
    far as our health care system and public health facilities in
    Kentucky, most of the rural people have to come to urban areas
    to get their health care public health services.
        Secretary Thompson. Right.
        Senator Bunning. Therefore, if some kind of bioterrorist
    attack would occur, say, in Laurel County, in London, Kentucky,
    the closest city is Lexington, which is about 65 or 70 miles. A
    lot of infection can happen, if it happened to be smallpox, by
    just going into Lexington. So are you telling me that----
        Secretary Thompson. In the case of smallpox, we would
    quarantine that area. We would move in immediately.
        Senator Bunning. If you knew it was there.
        Secretary Thompson. But we have to find out where it is,
    and then we move in immediately.
        Senator Bunning. You would quarantine the area that you
    would find----
        Secretary Thompson. Immediately.
        Senator Bunning. Immediately.
        Secretary Thompson. And we would send in people----
        Senator Bunning. And try to spread out a--would it not be--
    --
        Secretary Thompson. We would be able to ship in medical
    supplies, medical personnel, and experts from CDC within hours
    after that takes place. That is what the Health Alert Network
    is set up to do.
        Senator Bunning. OK.
        Secretary Thompson. That is what the laboratory analysis is
    set up to accomplish.
        Senator Bunning. Would it not be better if we inoculated
    and vaccinated our first responders up front?
        Secretary Thompson. We are looking at that right now,
    Senator, but there are problems with the inoculation of the
    smallpox vaccine.
        Senator Bunning. Sure there are. I mean, if you did 270
    million people, you would have 2,000 or 3,000 deaths.
        Secretary Thompson. That is right.
        Senator Bunning. I understand that.
        Secretary Thompson. And there are some----
        Senator Bunning. But if you are doing the first responders,
    you are not doing 270 million people.
        Secretary Thompson. And that is what we are looking at
    right now. We have got a group of specialists from CDC and NIH
    and from my office that are working on this right now, along
    with State medical societies and input from other medical
    personnel. They are evaluating right now whether or not first
    responders should be inoculated.
        Senator Bunning. Well, you are going to have to do it if
    you have an attack.
        Secretary Thompson. That is correct.
        Senator Bunning. And as long as it is good for how many
    years, an inoculation? It used to be 10 years. I do not know
    what your new or improved version might be, but----
        Secretary Thompson. The common position is it is good for
    10 years, but there seems to be, from the experiments and the
    evidence we have right now, it is longer than that, Senator
    Bunning, that there is a residual reserve capability or
    capacity to prevent smallpox.
        Senator Bunning. I want to go back to a ``60 Minutes''
    interview last September. You made a statement that the United
    States was ``prepared to take care of any contingency, any
    consequence that develops, for any kind of bioterrorism
    attack.'' You also said that ``we would advise on television,
    on radio, exactly what to do'' and that we would ``have people
    there within hours to take care of it, set up an action plan
    and we will implement it.''
        In light of all that we have learned about our preparedness
    to handle a bioterrorist attack during the anthrax attacks, do
    you think making this generalized statement was a mistake or
    just premature?
        Secretary Thompson. I think that we are better prepared--of
    course, we are much better prepared today than we were then. We
    were much better prepared than a lot of people thought. There
    are a lot of consequences that came in. The statement was too
    broad. But I wanted to make sure that people were----
        Senator Bunning. Well, I understand the calmness and the
    assuring of the American people.
        Secretary Thompson. But we responded very effectively,
    Senator Bunning, and there were billions, in fact, trillions of
    spores of anthrax that were sent through the mail--and it was
    the great medical personnel that we had at CDC and the local
    health departments that prevented a lot more deaths. Am I
    satisfied with the five deaths? Absolutely not.
        Senator Bunning. No one is satisfied, but I think that
    attack was limited very well as it turned out.
        Secretary Thompson. It was, and it was because of the
    expertise that we had and the preparation that had been made by
    the Department of Health and Human Services, CDC, and NIH. And
    now we want to go to the next step.
        There is no question, Senator, that the local and State
    public health system in America needs a lot more infusion of
    dollars and better preparation. That is why we are demanding
    these plans be submitted, and we are hopeful with this planning
    process and the $1.1 billion that we will be sending out that
    we can build a local and State public health system that is
    national in scope, that will be able to handle a bioterrorism
    attack, and that is what we are getting prepared for. It is a
    legacy that you can have and the Department can have and
    America can have.
        Senator Bunning. I pray for you, then, today and into the
    future, because we not only have to be prepared, we are going
    to have to be also very fortunate to be able to identify and
    quickly treat any kind of a bioterrorism attack and I wish you
    godspeed.
        Secretary Thompson. Thank you very much, Senator, but if I
    could just quickly respond, that is why we divided the country
    up into medical assistance teams, individuals we can activate
    quickly to be sent in at a very short period of time. That is
    why we have expanded our push packages from 8 to 12, our
    medical supplies, our medicines, our medical equipment from 400
    tons to 600 tons, and we have reduced the time from 12 hours,
    hopefully, down to 7 or 8 hours, that we can get 50 tons of
    medical supplies into Kentucky within 5 to 6 hours after an
    event. As soon as we are notified, we can dispatch that, and
    that is what we are hopeful to be able to accomplish and that
    is the planning that it is working on right now. And we are
    fairly certain that we can deliver on this.
        Senator Bunning. Thank you.
        Secretary Thompson. But the problem is, once it gets there,
    we have got to make sure that the local individuals are going
    to be able to use that equipment, use the medical supplies, and
    get it to the individuals quickly. And that is what the
    planning process is all about.
        Senator Bunning. Thank you. Senator Dayton.
        Senator Dayton. Thank you, Mr. Chairman. I appreciate the
    opportunity to speak. Thank you.
        Mr. Secretary, first of all, I want to say that what you
    have described here today is highly commendable. The speed with
    which you have responded and the progress you have made in
    terms of getting money out and getting supplies stockpiled, I
    think, is just outstanding and I think our Nation owes you a
    debt of gratitude for your efforts on our behalf, so thank you,
    sir.
        Secretary Thompson. It was the Department, sir, it was not
    me.
        Senator Dayton. I understand that, but it starts at the
    top.
        Secretary Thompson. Thank you.
        Senator Dayton. But it is a team effort, so I agree with
    you.
        Since you referenced the Kentucky plan, I have to evidence
    a parochial interest. Has Minnesota submitted a plan? I am not
    sure of the status.
        Secretary Thompson. Minnesota asked for a postponement this
    week.
        Senator Dayton. All right.
        Secretary Thompson. Minnesota asked for an extension to May
    15 to deliver their plan, Senator.
        Senator Dayton. Thank you. You mentioned the money that you
    have put out to the States and that you will be distributing
    additionally. In terms of local governments and local hospital
    units, public health facilities and the like, does that money
    go through the States to the local or does any of that go
    directly from your Department?
        Secretary Thompson. It goes directly from CDC and HRSA to
    the State health departments to implement their plan. They
    received 20 percent. Minnesota has received 20 percent of their
    amount of money. What is Minnesota going to receive? Minnesota
    will go through the State health department.
        But what we are forcing the State health departments to do,
    in conjunction with the governor, is to work with the city
    health departments, the county health departments, the
    hospitals, the State medical system, the first responders, and
    the law enforcement officials to develop a comprehensive plan
    for the State of Minnesota, and we have sent out templates of
    what we think a good plan should provide for. The State of
    Minnesota will send that.
        It will first be evaluated by CDC down in Atlanta. Then it
    will be evaluated by HRSA. Then it comes up to Washington, DC,
    where we have 11 teams to evaluate these plans after CDC and
    HRSA. Experts--doctors and so on from around the country, come
    in and evaluate the plans and make recommendations, and then
    they will be in consultation with the State health department
    officials about those corrections or modifications if there are
    any. And then the money will go out, hopefully by May 15, to
    those States that have submitted their plans and had them
    approved.
        We want the money to go out 30 days after a State has
    submitted a plan, and that is why we set up 11 teams and that
    is why CDC and HRSA are working this weekend to make the first
    evaluation.
        Senator Dayton. That is tremendous. Thank you.
        Secretary Thompson. Minnesota is going to receive
    $18,107,000.
        Senator Dayton. If they get their plan in eventually?
        Secretary Thompson. Yes.
        Senator Dayton. Thank you. It refers more to Governor
    Ridge's operation than your own, but I just want to ask the
    same question. I have had some complaints and a lot of concern
    by local officials in Minnesota that they feel they are out of
    the loop. They feel they do not have access to information
    regarding these developments and what their roles are supposed
    to be. Is that, as it relates to your department, then, the
    responsibility of the States to communicate with local units of
    government, as well, or is there a way in which they can
    directly access information, web pages, answering service, or
    anything?
        Secretary Thompson. The way we have got it set up, Senator,
    we have a web page both at NIH, at CDC, HRS, and the Department
    of Health and Human Services to get out the information. We
    have the Health Alert Network, which now is connected with 68
    percent of the counties and the population of America. And by
    the year's end, with the money that is going to be sent out,
    that should go up to 90 percent.
        Then we have what is called the laboratory network in which
    we have 80 laboratories, all the State laboratories plus some
    other laboratories, hooked up so that they have instant
    analysis, can communicate back and forth with one another and
    with CDC.
        And then if an incident breaks out, we will send an expert
    or experts from CDC immediately. If something would happen in
    St. Paul and there was an evaluation that there was anthrax, we
    would then send that to the State lab, send it to the CDC lab,
    get an evaluation. But in the meantime, we would send a team of
    experts from Atlanta to St. Paul to work with the local health
    department in St. Paul in the hospital, the emergency work to
    go over that patient to find out what needs to be done.
        Senator Dayton. The reference was made to CNN as a source
    of information. I would say that I received in the first 12
    hours a good part of my information from CNN and what I found,
    and I think other members of Congress found, too, is that our
    normal communication lines were ruptured or were so overloaded
    that communication was extremely difficult, sometimes
    impossible.
        You talk about the lines of communication you have
    established with States and with the public health centers that
    would be called upon in an emergency. How have you adapted that
    to the very real possibility that these traditional lines of
    communication might once again be disrupted or even ruptured?
        Secretary Thompson. Senator, we think we have taken that
    into consideration through the planning process and through the
    Health Alert Network, by expanding that through the websites
    and through the conference calls.
        At the height of the anthrax, we used to have weekly
    conference calls with CDC and with my office and sometimes with
    public health department officials. Anybody could call in and
    be connected. It happened either on a Thursday or a Friday. We
    also did it with the State medical societies. We did it with
    the emergency doctors. And those are the kinds of things, when
    there is an emergency, we would start that once again. But in
    the meantime, when there is not an emergency, we use the Health
    Alert Network, the web pages, and what is put out by CDC on a
    weekly basis on updates on medical analysis.
        Senator Dayton. Thank you, Mr. Secretary. Thank you, Mr.
    Chairman.
        Senator Cleland. Senator Carper, do you have any comments
    or questions?
        Senator Carper. I do. Governor, welcome.
        Secretary Thompson. Senator, how are you?
        Senator Carper. I am fine. How are you, my friend?
        Secretary Thompson. Good, my friend.
        Senator Carper. Glad that you could be with us today. We
    have gathered in our capital today, and this week, volunteer
    firemen and firewomen from around the country. About 250 will
    be at the National Fire Institute dinner this evening. I think
    the President is going to come to address them. We are having a
    ceremony honoring one of our fallen in Delaware, literally in
    the Capitol this afternoon. In some respects, they are our
    first line of defense in all kinds of emergencies, as you know.
        I would just ask, is there any message or anything that you
    would especially want me to convey to them on your behalf?
        Secretary Thompson. I would just say thank you. Thank you
    for the tremendous job that the men and women of the fire
    departments, volunteer as well as the paid officials, did
    during September 11. They were the calming influence in all
    communities across America. They truly did a yeoman's job and
    we are in their debt and I just would like to say thank you.
        Senator Carper. I will be happy to convey that.
        We had a hearing about, I want to say about 6 months ago
    when we were reeling with September 11 and then the anthrax
    attacks and have had an opportunity to do a whole lot. You have
    been very busy, your folks have, as well, and we thank you for
    your stewardship and for your leadership in some difficult
    times.
        I know that Senator Kennedy and Senator Frist have
    introduced legislation, I think it is called the Bioterrorism
    Preparedness Act. You may have commented on it in your
    testimony. I would ask you, could you share with me a thought
    or two that you have on what is good about it and maybe how it
    perhaps should be changed?
        Secretary Thompson. I think it is a wonderful piece of
    legislation right now. It sets up an Assistant Secretary for
    Biopreparedness Emergency in the Office of the Secretary. That
    office is currently being handled by Dr. D.A. Henderson. Jerry
    Hauer is the second in command there.
        It also allows us to do a lot for food inspections. It
    allows us to reject food that has been tainted in the past from
    a supplier, from a country. It also allows us to trace back the
    tainted food to the supplier. It also allows us to expand our
    inspections by giving us some additional personnel that we
    badly need. It also allows us to have a much better coordinated
    effort in bioterrorism through the Department of Health and
    Human Services.
        There is another big thing that the Senate, Senator
    Feinstein was very active in, and this was, of course, on the
    agents, the special agents. We had a meeting in the White House
    about it this week and what we are going to do is we are going
    to set up a register in the Department of Health and Human
    Services for all these agents, and then the Department of
    Agriculture has some of their own agents. We have duplication.
    And so the Department of Agriculture is going to have a list
    and be able to find out what agents are being utilized for
    laboratory investigations, what is being transported, and so
    on. The Department of Justice will have the opportunity to have
    instant access to the registers in the Department of Health and
    Human Services and the Department of Agriculture.
        Right now, the law is, Senator, that we can only--the only
    thing we monitor is the transportation, the transporting of
    these bio-agents. We do not know how they are used. We do not
    know if they have been used. We do not know what is in
    stockpile or so on. And this information, now, that this
    legislation is going to give us, is going to help us a great
    deal.
        Senator Carper. Good. In Delaware, we have been working
    over the last couple of years to put into place a disease
    tracking system. There is a name for it, the Delaware
    Electronic Reporting System. It would----
        Secretary Thompson. It is the best in the country, I might
    add, Tom.
        Senator Carper. Thanks for saying that. I wish I could take
    credit. Well, I will take credit for it. [Laughter.]
        Secretary Thompson. It happened while you were governor, so
    take credit for it.
        Senator Carper. One of the things I learned as governor is
    when things go wrong, accept the blame. When things go right,
    share the credit, so in this case we will give the credit to a
    lot of other folks.
        But I know that your Department is working on, I think, a
    similar national monitoring system and I was just wondering,
    how is it going? How far are you along there?
        Secretary Thompson. We have taken the template from
    Delaware and we have sent that to all the 50 State health
    departments saying this is a good example of how to be able to
    accomplish this objective. And so we have done that in many
    different areas, in communications, emergency preparations, and
    surge capacities, and we are sending that out and we are
    hopeful that they will use these templates to be able to build
    a very positive, comprehensive plan. But Delaware should get
    the credit because we have used it and I thank you for it.
        Senator Carper. Thank you. Thanks for sharing that credit.
        I have heard some people argue that a system like the one
    we are talking about, at least on a national level, would not
    enable us to detect future attacks like last fall's anthrax
    attacks. I do not know if you agree, and if you do, does this
    mean it is maybe a less worthwhile investment for us to make as
    a Nation?
        Secretary Thompson. What was that, Tom?
        Senator Carper. There are some who said that a system like
    we have in Delaware and that we are trying to spread across the
    country would not enable us to detect attacks like the anthrax
    attacks of this past fall. I do not know if you agree with that
    assessment, but whether you do or not, I wonder if that tempers
    at all your beliefs as to whether or not this is a worthwhile
    investment.
        Secretary Thompson. I think it is a very worthwhile
    investment and that is why we are trying to get it incorporated
    in all the State plans because we think it is important, that
    information.
        We also are looking for new innovations, Senator, on how to
    detect bioterrorism agents. There are some new innovations out
    there and we are hopeful to be able to maybe in the future get
    them in public buildings and the Capitol, and so on and so
    forth, that could discern if there is anthrax in the area. They
    have not been perfected yet. There are some out there, but
    there are a lot of innovations, a lot of new things that are
    coming to the Department, not only to our Department but the
    Department of Defense, and hopefully they will be able to
    discern when there is an agent in the vicinity.
        Senator Carper. I am struck by the number of usually fairly
    small businesses, small technology businesses, just in my own
    State who have been to see me to say, we have this technology,
    we have this device which we think is quite effective, whether
    it is detecting anthrax or some other agent. We have tried to
    provide a forum for them through the administration with the
    help of the Small Business Administration so that they may have
    an opportunity to present to the administration and the
    relevant agencies what they have worked on and what they have
    developed.
        I am just seeing what has come out of one little State. I
    cannot imagine what must be coming out of the rest of the
    country. My suspicion is that in Minnesota and Georgia and
    other places, that Senator Cleland and Senator Dayton are
    hearing from their businesses who are coming up with similar
    kinds of models that, frankly, we had not thought much about in
    recent years.
        Secretary Thompson. I think it is very positive.
        Senator Carper. The last subject is quite a different
    subject and I will just mention this as an aside. The
    administration was kind enough, I suspect with your urging, to
    invite a number of us in the Senate and in the House who were
    interested in next steps in welfare reform to a forum at the
    White House this afternoon that I am not going to be able to
    attend. I mentioned earlier we have a ceremony honoring one of
    our fallen fire fighters that will be in the Capitol literally
    right in the time frame that the event at the White House will
    be occurring on welfare reform. Do not judge my absence as a
    lack of interest.
        Secretary Thompson. I know.
        Senator Carper. We look forward to working with you on it.
    Thanks.
        Secretary Thompson. Thank you very much, Senator Carper.
        Senator Cleland. I thank all of the Members of the
    Committee for involving themselves in this discussion today,
    and again, Mr. Secretary, we thank you very much for your help
    here.
        I just want to get into some basic, fundamental conflicts,
    if you will, challenges, problems that we need to work out
    together, and I would like to just say again, I would like to
    work it out with you, with the Members of the Committee.
        Congressman John Lewis has said it beautifully, that we may
    have come to this country in different ships, but we are all in
    the same boat now, so we are in the same boat here.
        I was just sitting here thinking about the difference, the
    dramatic difference, I think, between, shall we say, a
    military/terrorism attack on the country and when that attack
    goes biological. First of all, I think an attack on the country
    requires some delivery system. We saw that initially the al
    Qaeda went after us at the Khobar Towers with a car bomb, then
    later with a truck bomb at the World Trade Center, the two
    embassies in Africa, then ultimately a boat bomb against the
    U.S.S. Cole, and finally a plane bomb against the World Trade
    Center and the Pentagon.
        So some overt attack to create mass destruction or
    confusion, which is the object of terrorism, which makes it so
    terrifying, requires some kind of delivery system. But if you
    take that attack biological, that really is very difficult to
    detect. The delivery system for killing 100,000 people could be
    one envelope delivered to Senator Patrick Leahy's office. The
    anthrax spores there, I am told, were enough to kill 100,000
    people.
        Secretary Thompson. That is true.
        Senator Cleland. So I think we have a new ballgame when the
    attack goes biological or chemical and it is interesting how
    there is really a dichotomy in law and a dichotomy in many ways
    in practice that we have now and that we have got to resolve
    and work out somehow that led to some of the problems, the
    initial problems with responding to anthrax.
        In many ways, I could boil it down this way. One part of
    our law, based on Presidential directive, says, in effect, the
    FBI is the lead dog, the lead agent, and HHS is in support of
    FEMA, a back-up agency, in terms of biological help. The other
    part of our law, which is actually in law, authorizes the
    Secretary of HHS to actually initiate certain things--we can
    get into that--to include investigations.
        It is interesting, too, we have a FBI and then we have a
    bug FBI. The bug FBI is the CDC. They have the epidemiological
    investigative service. So when things get buggy, they are the
    agent, in many ways, of expertise. They have been around 50
    years there in the CDC.
        Secretary Thompson. That is right.
        Senator Cleland. What I am trying to do is try to make
    sense of these great assets and instill or work out some kind
    of better coordination, cooperation, and communication.
        First of all, I think we have got to acknowledge some of
    the problems. Last fall with the anthrax attack, a bug attack
    which, thank God, the CDC quickly identified, therein, though,
    once the CDC identified it, it became this tug of war between
    public health agencies and law enforcement agencies. Just some
    examples.
        In Trenton, New Jersey, the FBI and public health agencies
    could not agree on who should take environmental samples, so
    they both did. In Washington, DC, health officials first
    learned that there was contamination in several Federal
    agencies from the news media, I guess CNN.
        In New York, law enforcement officials knew but failed to
    notify city health officials that a suspicious letter had been
    sent to NBC News until after the first case of infection
    surfaced. When the FBI took over in Florida after the CDC had
    identified the substance as anthrax, when the FBI took over in
    Florida, press briefings by public health officials halted at
    the FBI's request.
        Another example. Samples collected by the FBI in
    Washington, particularly in terms of the Daschle letter, were
    sent to military laboratories, Army labs at Fort Detrick,
    Maryland, for analysis, not to CDC.
        Finally, a Canadian study on anthrax showed that anthrax
    spores could escape sealed envelopes in large quantities. At
    least half-a-dozen U.S. agencies knew about this study prior to
    the anthrax attacks, but because of individual stovepiping of
    information, turf battles, budget battles, the CDC did not
    know. The CDC had received, interestingly enough, an E-mail
    regarding that study on October 9, before the Daschle letter
    arrived and before anyone at Brentwood fell ill, but no one
    there read it until November.
        The problem is, I think we have a problem. Senator Nunn has
    indicated something of interest. He played the President in an
    exercise called Dark Winter put on by Johns Hopkins in June of
    last year, about 90 days before the attack here on September
    11. That was a drill on a smallpox attack in America, and out
    of that, Senator Nunn testified before the Congress some
    challenges.
        He said, ``you have got an inherent conflict between health
    and law enforcement,'' and he said, ``and to the extent that
    they have not coordinated beforehand and do not know each other
    beforehand, before the occurrence took place, you would have a
    horror show because law enforcement has one set of goals and
    health officials have another set of goals.''
        What are those goals? Well, law enforcement deals in
    secrecy. I understand the FBI wants to keep things secret. The
    public health entities, from the CDC on down, deal in openness.
    They want to disclose and disseminate information.
        I am concerned that the protocols of response, of
    communication and coordination between Federal responders in
    the event of a bioterrorism attack are not clear.
        As I mentioned, executive documents seem fairly
    straightforward. The U.S. Government interagency domestic
    terrorism concept of operation plan, called CONPLAN, issued in
    2001, sets forth how the Federal Government will respond to a
    terrorist incident and how the various Federal agencies are to
    coordinate with one another in the event of such an incident.
    The CONPLAN draws on and is in accordance with authorities
    established in two Presidential directives, Directives 39 and
    62, the Federal response plan, including a lot of backup.
        The CONPLAN designates the FBI as the lead Federal agency
    for crisis management in the event of domestic terrorism. FEMA
    is designated as the lead Federal agency for consequence
    management to ensure that there is only one overall lead
    Federal agency at a time. And then HHS is in a support role
    under the CONPLAN.
        Now, interestingly enough, another directive that you are
    caught in is law. It seems that a law, the Public Health
    Threats and Emergencies Act, gives explicit authorization to
    the Secretary of HHS to declare a public health emergency on
    your own, in effect, and in the event of such declaration, to
    do whatever is necessary to respond to it, including
    conducting, not merely supporting but conducting your own
    investigations into the cause and means and steps to be taken.
        It seems under the CONPLAN, the HHS can do only those kinds
    of things in support, based on request. But the law, the Public
    Health Threats and Emergencies Act, in effect, says you have
    authority whenever the public health is in danger.
        I think somehow we have got to clarify this. I think you
    are caught in a bind. There are very real scenarios under which
    the interest of law enforcement and public health do conflict.
        May I say that the FBI, as the lead Federal agency, is
    generally the first agency to obtain new information. If it
    decides that a new piece of information has a bearing on public
    health, it then communicates that to health authorities. As a
    number of experts have noted, the FBI is not a public health
    agency. They may not necessarily know what information can be
    of significance to public health officials.
        I would like to know, what is your understanding now of the
    relationship between the roles of law enforcement and public
    health in the event of a bioterrorist attack on our country? Do
    you feel that you have sufficient authority under the law to
    initiate action, whether through the CDC or some other agency
    under your command, to, in effect, declare a public health
    emergency and begin preparing to deal with it?
        Secretary Thompson. As you know, Senator, I did declare a
    public health emergency on September 11, and did use that
    power. But I think it does need clarifying. I think you are
    absolutely correct. There seems to be some confusion, and so in
    order to have a more comprehensive way of getting the
    information out, we have set up what is called advisory
    committees. These are the committees set up by the State and
    local health departments and government, emergency management
    agencies, emergency medical services, Office of Rural Health,
    police, fire department, emergency rescue and occupational
    health workers, Red Cross and other voluntary organizations,
    the hospital community, community health centers, and other
    health care providers. These are the advisory committees that
    we have asked the States to put in their comprehensive plans so
    in case of an emergency, in case of a bioterrorist attack,
    these committees would come together and be able to distill the
    information and be able to speak with one voice.
        But at the Federal level, I think there is some confusion
    and if we could sit down with the Department of Justice and
    Office of Homeland Security, I think we could work it out. But
    there is very good cooperation. I do not want you to in any way
    imply from my answer that there is not good cooperation right
    now.
        For instance, we have somebody from CDC, and I do not know
    if you know this, Senator Cleland, that meets with the FBI
    every week with regard to new evaluations on anthrax. So we
    have one of our experts from CDC that meets with an FBI team
    weekly on their analysis. Jerry Hauer meets with them every
    other week with regard to the investigation on anthrax. And I
    meet with the Director and other members monthly as to new
    developments on anthrax. At the height of it, we met weekly.
        So there is great cooperation now, but in the law, in the
    emergency rules, there is some confusion that I think needs to
    be clarified.
        Senator Cleland. And it does seem to me that in case of a
    bioterrorism attack, a chemical attack, you have the agencies,
    the resources to deal with it and you ought to be the lead dog.
    There are other entities involved. I am not sure they make it
    better or worse for you to take the lead. There is now the
    Office of Homeland Security to coordinate with and now there is
    Dr. Henderson in your new office that you have created. You
    have got the CDC. You have got the NIH. You have got FEMA. You
    have got the FBI.
        I think that is my problem, is that we have got about 20
    different agencies involved in bioterrorism and what I am
    trying to do is kind of sort out the protocol here before the
    next attack. In other words, make sure people basically
    understand their role and responsibilities when the next time
    the popcorn hits the fan so that we do not have to go through
    the drills that we went through last fall.
        Secretary Thompson. FEMA now defers to the Department of
    Health and Human Services on anything and everything that deals
    with bioterrorism, and so that has been--it is not in the rule,
    it is not in executive order, but that is common practice. And
    the FBI has been very cooperative. In fact, I have just been
    corrected. We have a full-time official from CDC working in the
    FBI right now on the anthrax question.
        Senator Dayton. Mr. Chairman, could I just excuse myself? I
    am sorry to have to leave. I have a press conference call with
    the Minnesota press. I apologize for having to go. Mr.
    Secretary, thank you.
        Senator Cleland. Thank you very much.
        Secretary Thompson. Thank you, Senator Dayton.
        Senator Cleland. In the National Journal, HHS spokesman
    Kevin Keene is quoted as acknowledging that under the
    Department's consolidation plan, one agency or one voice or
    something like that, which is a noble enterprise, but I think
    we are concerned, I am concerned about whether or not this will
    add an additional layer of review by the Secretary's office. I
    mean, I understand about speaking with one voice. I also am
    interested in speaking with a medical or expert voice as
    opposed to a political voice.
        I just want to get your understanding of whether or not
    what you are trying to do is going to speed up, where speed is
    of the essence and communications is of the essence, or slow
    down information that your Department has that needs to be
    disseminated to the public.
        Secretary Thompson. I think it is going to speed it up and
    I think it is going to be much more effective, Senator. We do
    not in any way want to infringe upon the scientific utilization
    of the media. In fact, we encourage it. We want to make sure
    that CDC continues to have the Health Alert Network, continues
    to have their Public Affairs Department, continues to put out
    their MMWR on a weekly basis with information. We want them to
    continue to set up the conference calls with regard to how we
    get the information out. All of this is not going to be touched
    at all.
        What we are trying to do--we have got 50 different public
    affairs departments, 50 public affairs offices within the
    Department of Health and Human Services. In the case of a
    bioterrorism thing, we want to make sure that what is going on
    in CDC, at NIH, and FDA is coordinated with the new office, and
    hopefully the Assistant Secretary for Public Health
    Preparedness, and that is headed by Dr. D.A. Henderson, so that
    we are able to speak clear, concise, straightforward, directly,
    and quickly about the effect.
        What we did during the height of the anthrax things, we had
    people like Dr. D.A. Henderson, Dr. Tony Fauci from NIH, Jeff
    Copeland from CDC, myself, and other individuals who weekly met
    with the press and we had a teleconference call for any updates
    with regard to bioterrorism.
        We would incorporate that so that CDC, NIH, FDA, and the
    new office or Assistant Secretary's Office for Public Health
    Preparedness would be able to coordinate their message and get
    it out quickly, and usually by a doctor.
        Senator Cleland. Maybe I am just a little stream of
    consciousness thinking here. When the Secretary of Defense
    briefs the public, the press, on, say, military operations, he
    always has, in effect, the Chairman of the Joint Chiefs
    standing there to answer ``military expertise'' questions.
        It does seem like that in the homeland defense arena, the
    strategy for defending our homeland, if it becomes a biological
    issue, there are a number of bugs out there that we can be
    attacked with. It seems to me your great agency, particularly
    in the CDC, has the capability to draw upon some expert that
    knows about that and, in effect, becomes your equivalent of the
    Chairman of the Joint Chiefs of Staff standing there answering
    questions about that particular bug or device or gas.
        Secretary Thompson. That is why we put Jeff Copeland out
    just about--we made him available every week with regard to
    talking to CNN and talking to the press. We also made available
    the Surgeon General, David Satcher, and Dr. D.A. Henderson.
    They were the spokespeople, and Tony Fauci from NIH. Those were
    the spokespersons for the Department as relates to the medical
    provisions of bioterrorism.
        Senator Cleland. Experts in the field like Dr. Tara
    O'Toole, whose colleague Tom Inglesby we will hear from in the
    second panel, keep telling us that we need to have medical
    professionals out there answering questions and disseminating
    information.
        Secretary Thompson. I agree with that.
        Senator Cleland. It is interesting that in 1993, during the
    hanta virus outbreak, then-Secretary of HHS Donna Shalala
    deferred and let C.J. Peters, the Chief of Special Pathogens at
    the CDC, take the lead and be the voice of the public health
    establishment. I am sure you get that point.
        Budget issues--in 2000, the Congress committed to a 10-year
    master plan for revitalizing the CDC's World War II era
    facilities. I have visited those facilities. How did it get to
    be World War II? Well, first of all, in many ways, you had a
    little public health operation down there just off the field of
    a Naval air station and they were basically an Army operation
    dealing with malaria, and in many ways, that is how that grew
    there. Actually, back in the 1960's, it was Mr. Woodruff of
    Coca-Cola fame who worked with Emory to donate some land across
    from Emory and that became, in effect, the CDC headquarters. So
    it just kind of grew, but now very much in need of a master
    plan to bring it into the 20th Century and out of the World War
    II era facilities.
        In 2000, we put together about $175 million for buildings
    and facilities, actually in fiscal year 2001. Last year, after
    the anthrax attacks, we put together about $250 million. The
    President came to the CDC and praised the CDC for its work.
    That compressed the 10-year plan to about 5 to 7 years, which
    we felt was proper for the country to begin getting on top of
    the master plan because we could not wait another 10 years for
    some terrorist attack.
        It seemed to me that the Congress committed at that time to
    maintaining a funding level of $250 million per year
    specifically for CDC in campus buildings and facilities until
    the plan was complete. After we passed that legislation, we
    allocated an additional $46 million for security.
        The administration has proposed a total of just $90 million
    specifically for the CDC's master plan 2003, and I expressed my
    concern to you over this meager funding level and you were kind
    enough to write back. In your response, you wrote that the
    administration proposes $184 million for buildings, facilities,
    and security in fiscal year 2003 across the board, which when
    combined with $296 million the CDC received for buildings,
    facilities, and security last year brings a 2-year total to
    $490 million, seemingly close to the needed $200 million per
    year.
        However, the master plan that Congress committed to is for
    the upgrading and revitalization of the CDC's buildings and its
    facilities at its headquarters in Atlanta. Funds for needed
    security upgrades are not figured into it. Neither are funds
    for projects that are not located at the headquarters in
    Atlanta.
        Of the $184 million the administration has proposed for
    fiscal year 2003, $74 million is for the construction of an
    entirely new facility in Fort Collins, Colorado, and $20
    million for security. That leaves just $90 million for master
    plan-related projects, a lower amount even than the $175
    million Congress appropriated 2 years ago that will be required
    to keep us on a 10-year plan.
        My question is, where does the administration's proposed
    budget for the CDC put us in terms of implementing the 10-year
    plan?
        Secretary Thompson. Senator, let me tell you that I totally
    agree with the need to upgrade the CDC campus. I have been
    there. In fact, I spent a week there as I move my office around
    to various divisions. One week out of the month, I spend the
    week in Atlanta at CDC.
        There are three campuses at CDC, as you know. There are 24
    other rented buildings. A lot of the buildings on those
    campuses are old, dilapidated, a lot of laboratories, and a lot
    of security problems. There is no question that the $250
    million is needed. But when you are fighting a war both
    internationally and domestically through homeland security, you
    have given so much in dollars, you have to put together the
    best plan possible.
        We are putting $74 million into Fort Collins, which is a
    CDC building, which is badly needed. I do not know if you have
    seen the pictures, but it is absolutely badly needed. In fact,
    some of the research cannot be done during some of the months
    of the year because of ventilation and because some of the
    encroachment of mice and rats and snakes that get into the
    building. So that was a top priority. We had to do the $74
    million for Fort Collins.
        We have to build a new laboratory, a level four laboratory,
    at Fort Detrick, and we have to remodel some labs at NIH in
    Montana for NIH. So we looked at the amount of dollars that we
    had. We stretched them as far as we could go and that is what
    we ended up with.
        All I can tell you is that I fully support, and hopefully,
    next year, we will be able to do more for CDC. They need to
    consolidate and we need to get out of that rental space and we
    need to consolidate those buildings on three campuses. But with
    the dollars that we had, we put together the budget. We thought
    there were higher priorities this year because CDC got a nice
    tranche of money last year for buildings, and hopefully, next
    year, we will be able to do a better job.
        Senator Cleland. You can understand the fact that I feel
    strongly about this and will continue to push in the Senate----
        Secretary Thompson. I know you do, and I compliment you on
    it, Senator----
        Senator Cleland [continuing]. For additional monies for the
    CDC----
        Secretary Thompson [continuing]. And I want to work with
    you on it.
        Senator Cleland [continuing]. To stick to that effort that
    Congress committed itself to and the President, I thought,
    signed onto to collapse the 10-year master plan into about a 5-
    year plan because we cannot wait on the next terrorist attack.
        I would like to just bounce off you this idea, this concept
    that I put forward, the National Center for Bioterrorism
    Preparedness and Response in the CDC. Again, most of the CDC's
    budget is broken down into allocations to centers----
        Secretary Thompson. Right.
        Senator Cleland [continuing]. In an effort to enhance
    coordination, cooperation, and communication, and
    accountability for these $6 billion or so we are spending on
    bioterrorism among 20 different agencies. In an effort to put
    together a nerve center that would operate 24 hours a day, 7
    days a week, and be available to provide our first responders
    and our citizen with what we need out there, you can understand
    that after looking at the master plan, I considered that it
    would be a logical step to put together a center there.
        Now, what do we mean by a center? One of the concepts that
    I had in mind is the concept by Jeff Koplan, the former CDC
    Director, about a $65 million center to address the most urgent
    security deficiencies in the agency. The current headquarters
    facility and emergency operations center are located in
    buildings less than 30 feet from a major street. The new, in
    effect, center, bioterrorism center, would be located in a
    secure spot and house a secure compartmental information
    facility for communicating with the Secretary of HHS, the White
    House, and intelligence agencies during an emergency.
        We have that kind of facility in the Pentagon for outright
    attacks. We do not have that kind of nerve center and facility,
    situation room, where everybody can be tied in and can
    communicate to one another really in times of a bug attack or
    bioterrorism attack or chemical attack, and it seems to me that
    that would be a logical step that we would include in the 10-
    year plan. Do you have any comment on that?
        Secretary Thompson. Senator, I agree with you. I thought it
    was a great idea. In fact, we were going to look at
    reorganizing CDC to accomplish that administratively. But I was
    dissuaded, not by people up here, but I was dissuaded by the
    people in Atlanta that that was not a good idea, and they told
    me the reasons why.
        They said that we have bioterrorism in chronic diseases. We
    have bioterrorism in infectious diseases. We have bioterrorism
    activities in the National Center for Environmental Health. And
    we have bioterrorism activities going on at ATSDR for the
    Superfund. And we have bioterrorism activities going on with
    the State health departments. We think if you consolidated all
    of that into one center, that we would lose something in the
    process.
        So since they were the experts, I listened to them and I
    went along with that. But I have to admit that what you are
    saying has some merit to it and I would like to work with you
    and see if we could accomplish both objectives.
        Senator Cleland. I do not want to beat it to death. We are
    going to have Dr. Inglesby in a few minutes, and his testimony
    and statement says there is a need for experts from a variety
    of scientific backgrounds, experts in experimental biology,
    epidemiology, infectious disease medicine, anthrax vaccine
    science, and immunology to work together on bioterrorism
    events. That is his testimony. The CDC center would bring
    together these experts.
        Interestingly enough, in terms of an attack on this
    country, biological agents could be combined with chemical
    agents like sarin gas or weaponized in unknown ways. The
    combined expertise at the center, I think, could help.
        Dr. Jeff Koplan, the former Director of CDC, stated that,
    ``Dozens of staff representing several of the laboratories and
    centers are dedicated to bioterrorism activities, but most do
    not focus exclusively on bioterrorism.'' That is the point, I
    think, you were making.
        Secretary Thompson. Yes.
        Senator Cleland. It is illogical to expect these staff to
    be more proficient and effective as a team when 70 percent or
    more of their time is spent on other duties and 30 percent or
    less on bioterrorism.
        I would just like to put some of these points in the
    record, and we will hear from Dr. Inglesby in just a moment.
        But it is something that I will continue to work on because
    it does seem to make sense, and also from the private sector,
    Bernie Marcus, the founder of Home Depot, along with Art Blanc,
    just donated $4 million to the CDC for the very purpose of
    equipping a nerve center like this, and I have noticed that
    they did not turn that down. [Laughter.]
        We will continue to press on in the vineyard.
        Secretary Thompson. I congratulated him and thanked him
    very much for that. We appreciate that.
        Senator Cleland. You have been very kind and very
    cooperative today. We thank you very much. We are in the same
    boat, and thank you for grabbing your oar and paddling like the
    dickens.
        Secretary Thompson. Thank you, Senator Cleland, for having
    this meeting and thank you for being here, and I want to
    cooperate with you and work with you on that bioterrorism thing
    and see if we can work it out so that we can come up with a
    comprehensive plan.
        Senator Cleland. Thank you, sir.
        We will have a 10-minute break before the second panel.
        [Recess.]
        Senator Cleland. The Committee will come back to order. I
    have been told that we will have a vote here momentarily, so
    let me just move right along.
        The Committee has heard an update from Secretary Thompson
    on the Department of Health and Human Services' public health
    preparedness for terrorism involving weapons of mass
    destruction, particularly biological agents. Committee Members
    have also addressed their concerns and proposals for
    Congressional action.
        We are very fortunate today to have our second panel of
    bioterrorism and public health experts to respond to our
    earlier discussion and to share your insights. I am very
    pleased to introduce our panelists.
        Dr. Margaret Hamburg is the Vice President for Biological
    Programs at the Nuclear Threat Initiative, put together by Ted
    Turner and run by Sam Nunn. Dr. Hamburg has testified at
    earlier hearings and has been an invaluable resource on
    bioterrorism and weapons of mass destruction.
        Dr. Tom Inglesby is Deputy Director of the Johns Hopkins
    Center on Civilian Biodefense Strategies, a wonderful
    operation, and we thank you very much. Dr. Inglesby is also a
    physician and specializes in infectious disease medicine. We
    are glad to have you.
        Tom Milne is Executive Director of the National Association
    of County and City Health Officials and has 15 years of
    experience as a local public health director in Washington
    State. Welcome.
        We look forward to hearing an update on public health
    preparedness for bioterrorism. Dr. Hamburg, would you please
    begin our discussion for our second panel.

     TESTIMONY OF MARGARET A. HAMBURG, M.D.,\1\ VICE PRESIDENT FOR
             BIOLOGICAL PROGRAMS, NUCLEAR THREAT INITIATIVE

        Dr. Hamburg. Thank you very much, Mr. Chairman, for the
    invitation today to speak today on the topic of the state of
    public health preparedness for terrorism involving weapons of
    mass destruction. Certainly, your leadership and commitment in
    addressing this challenge come at a crucial time.
    ---------------------------------------------------------------------------
        \1\ The prepared statement of Dr. Hamburg appears in the Appendix
    on page 54.
    ---------------------------------------------------------------------------
        Since the events of the fall, considerable new money and
    attention has been directed towards this problem and they are
    vital. The response to the anthrax letter attacks surfaced many
    critical concerns about public health preparedness,
    particularly with respect to the issues of coordination and
    communication that the Committee has indicated a strong
    interest in.
        It underscored the difficulties of understanding and
    coordinating the complex interactions between different
    agencies of government, different levels of government, and the
    private sector, all of which have important roles to play.
    Responding to this bioterrorist attack required new levels of
    partnership between public health, medicine, law enforcement,
    and the intelligence community. However, these communities did
    not have enough previous experience working together and vast
    differences in their professional cultures, missions, and needs
    clashed.
        The events of the fall also highlighted the pivotal role of
    the media and how an open and constructive partnership with the
    media is paramount in communicating important information to
    the public and reducing the potential for confusion, fear, and
    panic.
        Last, the management of the crisis was complicated by the
    fragmented and under-resourced infrastructure for public health
    and an already strained health care system.
        Many things must be done. I have submitted much more
    detailed formal testimony for the record and I am also
    submitting a recent editorial I did in Science magazine on
    public health preparedness for the record.\1\
    ---------------------------------------------------------------------------
        \1\ The Feb. 22, 2002 article entitled ``Public Health
    Preparedness,'' from Science magazine submitted by Dr. Hamburg appears
    in the Appendix on page 66.
    ---------------------------------------------------------------------------
        I want to take my time now to mention a few broad concerns
    related to the problems of coordination and communication.
        First, a comprehensive and systematic evaluation of the
    anthrax response should be undertaken. Surprisingly, this has
    not yet been done, to the best of my knowledge. Looking within
    and across the relevant agencies of government, levels of
    government, and at the relationships of private sector
    organizations, an informed analysis with identification of gaps
    in preparedness and response and realistic recommendations for
    improvement will be of enormous value. A number of entities
    could undertake this, but there is some urgency to do so before
    events fade from memory and new priorities overwhelm us, and it
    cannot just be an individual agency by agency listing of
    lessons learned but a true cross-cutting analysis.
        Clearly, we need comprehensive integrated planning. As
    Senator Cleland noted, we still need to more clearly define the
    relative roles and responsibilities of different agencies
    involved and the mechanisms by which they will interact and
    work together and do this before we are in the midst of a
    crisis.
        In addition, we still have not adequately prepared top
    officials to cope with this new type of security crisis. We
    have not invested adequately in the planning exercises needed
    to implement a coordinated response, and we have not adequately
    educated the American people or developed strategies to
    constructively engage the media to communicate critical
    information about what is happening and how to protect
    themselves.
        The new Office of Homeland Security is clearly key to such
    efforts, but there are concerns. It is difficult to imagine how
    Governor Ridge can successfully bring together and coordinate
    all the myriad agencies responsible for the different aspects
    of homeland security without budgetary authority, or at a
    minimum, budget review and sign-off authority, and cabinet-
    level status making him at least co-equal to the other members
    of the homeland security team.
        In addition to the Executive Branch, coordination is needed
    with respect to the activities here in Congress. I am told that
    literally dozens of committees and subcommittees are involved,
    and given the complex and multi-disciplinary nature of the
    problem, it is not surprising that a wide array of committees
    would have a role to play and completely appropriately.
    Nonetheless, assuring the comprehensive and well-integrated
    strategies needed will not occur unless there is equivalent
    integration, coordination, and communication among committees
    and leadership on the Hill, and I think this Committee is well
    positioned to help serve that effort.
        As noted by others, key to effective public health
    preparedness is public health itself. It is an important pillar
    in our national security framework and must be a full partner
    at the table. The chair is closer today than it was before, but
    it still is not full square there. Public health expertise must
    be a prominent component of the new Office of Homeland
    Security, and a public health official, in my view, should
    become part of the White House National Security Council.
        And on the ground, there is an urgent need to strengthen
    and extend the core capacities of our public health system. Our
    infrastructure----
        Senator Cleland. Dr. Hamburg, we have a vote called. If you
    do not mind, could you submit that for the record?
        Dr. Hamburg. Certainly.
        Senator Cleland. Dr. Inglesby, could you say some wonderful
    things to us, and Mr. Milne? I would hate to leave here and let
    you all hang. Could we move to Dr. Inglesby?
        Dr. Hamburg. Certainly.

      TESTIMONY OF THOMAS V. INGLESBY, M.D.,\1\ DEPUTY DIRECTOR,
        JOHNS HOPKINS CENTER FOR CIVILIAN BIODEFENSE STRATEGIES

        Dr. Inglesby. Senator Cleland, thank you and the other
    distinguished Members of the Committee for this hearing.
    ---------------------------------------------------------------------------
        \1\ The prepared statement of Dr. Inglesby appears in the Appendix
    on page 67.
    ---------------------------------------------------------------------------
        First, I would like to say that it is important to
    understand that the anthrax attacks of 2001 produced an
    extremely complicated set of management problems. CDC had to
    act faster than it ever had acted before, had to work with
    public health agencies like it had never done before,
    communicate with clinicians and nurses like never before, on a
    scale and a speed which was unprecedented. So there were
    professionals in all of these agencies, public health agencies,
    working around the clock, extremely dedicated, with the best
    intentions and a number of good successes throughout the
    crisis.
        But with all this being said, in my analysis, there are at
    least three categories of communication breakdowns that are
    worth calling attention to as we figure out what to do as we
    move forward. The three categories were the processes of
    incoming communication, the processes for resolving scientific
    issues during the crisis, and the processes of outgoing
    communication.
        I mean by incoming communication the processes by which
    clinicians and doctors who are seeing illnesses or suspected
    illnesses could communicate their concerns to public health
    agencies and to the CDC. In addition to that, there were data
    streams coming from a variety of directions regarding
    environmental health data and laboratory data which were coming
    forward at a pace and of a scale which had never been done
    before. So simply the task of integrating the data and
    processing it and forwarding it to public health decisionmakers
    was a tremendous challenge for public health agencies.
        The second category of issues regarded what you mentioned
    before on the first panel, and that was the processes for
    resolving the complicated science issues that arose during the
    crisis. Most people look to CDC for their technical expertise
    to resolve scientific questions, and that is absolutely
    appropriate. But during the crisis, we saw science questions
    that could not be solved by people within CDC alone, and CDC
    certainly was aware of that and tried to develop processes to
    answer questions.
        But as an example, we ask the question: ``Who should get
    the anthrax vaccine, if anyone? '' Of those affected by the
    anthrax crisis? To answer that question, you needed to know how
    likely it was that anthrax spores would cause disease after
    weeks of being in the body dormant? How likely was it that you
    could diagnose anthrax safely early after the infection begins?
    How much anthrax vaccine do we have and when will we have more?
    How safe are the existing anthrax vaccine stocks? All of these
    questions mandate that we have a variety of scientific
    competencies at the table, and you have mentioned those
    already.
        Senator Cleland. Dr. Inglesby, can we have you summarize
    and move on to Mr. Milne?
        Dr. Inglesby. Absolutely. So I think, in short, the highest
    level recommendations I would submit for improving
    communication: (1) improved connectivity between public health
    agencies and the medical system. There is a breakdown there
    that is real. Doctors and nurses are not part of the Health
    Alert Network. So even if we resolve problems of the Health
    Alert Network, doctors and nurses are still out of the loop.
        (2) Clinical information needs to get around the system, as
    well. Doctors and nurses have a responsibility for figuring out
    how we are going to get information to each other, and that is
    a separate problem. Once it is in our system, how do we get to
    each other?
        (3) How do we resolve science questions in the middle of a
    crisis? How do we communicate better with the public, even if
    it is bad news? What is the way to do that best?
        (4) And finally, exercises are extremely important, and I
    think a number of initiatives that the Senate has brought up
    for consideration are extremely useful along these lines.
    Senator Carnahan has legislation pending, Senator Lieberman has
    legislation, and so do you, all of which are aimed at
    addressing some of these deficiencies.
        Senator Cleland. Thank you, Doctor. Mr. Milne.

    TESTIMONY OF THOMAS L. MILNE,\1\ EXECUTIVE DIRECTOR, GOVERNANCE
     SUPPORT TEAM, NATIONAL ASSOCIATION OF COUNTY AND CITY HEALTH
                           OFFICIALS (NACCHO)

        Mr. Milne. Thank you, Senator. I am Tom Milne with the
    National Association of County and City Health Officials. We
    were asked to provide testimony on two issues. I will be very
    brief on both.
    ---------------------------------------------------------------------------
        \1\ The prepared statement of Mr. Milne appears in the Appendix on
    page 74.
    ---------------------------------------------------------------------------
        The first has to do with the relationship between law
    enforcement and public health. The second is a progress report
    to you in terms of how the appropriation of Federal
    bioterrorism funding is translating to action at the local
    level. Our submitted testimony provides a great deal of detail
    on both issues.
        Just in brief, an effective response at the local level to
    bioterrorism requires close collaboration between law
    enforcement and public health, and I am happy to report to you,
    sir, that is going very well with local law enforcement
    agencies and local public health. In fact, there is a long
    history of the two sectors working together.
        There are many examples in my testimony. I would highlight
    one: In the Fulton County Health Department and in the DeKalb
    County Board of Health in your own State of Georgia, there is
    an exquisite emergency plan that incorporates law enforcement,
    public health, and many other first responders.
        If there is a problem in collaboration between public
    health and law enforcement, it is in the lack of clarity in
    terms of how the various channels of Federal resources can be
    used at the State and local levels.
        Second, in terms of how the funding is translating at the
    local level, it is too early to tell much. What I can say is
    there have been mixed results in terms of how the process is
    going between States and locals. We have concern that enough
    money will not make it to the local level to make the
    difference that is needed. We strongly recommend that Federal
    monitoring of how the resources are ultimately used take place.
    There are some States where State and local collaboration has
    been very effective. So there is some hope.
        So in very brief summary, the public health infrastructure
    is critical to bioterrorism, but it also serves dual purposes
    to building the national public health capacity on a much
    broader scale.
        Senator Cleland. Wonderful.
        Mr. Milne. Thank you very much.
        Senator Cleland. Thank you all very much. I deeply regret
    that I have got only 5 minutes left for this vote. You all have
    been wonderful, very patient. Your testimony means an awful lot
    to me and we will take it into account.
        By the way, the record stays open for a week for any
    statement or questions or testimony that you want to submit. We
    have some questions we would like to submit to you for the
    record.
        With that, we thank you very much for coming and thank the
    staff for putting this hearing together.
        The Committee is adjourned.
        [Whereupon, at 12:01 p.m., the Committee was adjourned.]
                                A P P E N D I X

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