- LOCAL CHALLENGES OF GLOBAL PROPORTIONS: EVALUATING ROLES, PREPAREDNESS FOR, AND SURVEILLANCE OF PANDEMIC INFLUENZA

[Senate Hearing 110-451]
[From the U.S. Government Publishing Office]

S. Hrg. 110-451

LOCAL CHALLENGES OF GLOBAL PROPORTIONS: EVALUATING ROLES, PREPAREDNESS
FOR, AND SURVEILLANCE OF PANDEMIC INFLUENZA
=======================================================================

HEARINGS

before the

OVERSIGHT OF GOVERNMENT MANAGEMENT,
THE FEDERAL WORKFORCE, AND THE
DISTRICT OF COLUMBIA SUBCOMMITTEE

of the

COMMITTEE ON
HOMELAND SECURITY AND
GOVERNMENTAL AFFAIRS
UNITED STATES SENATE

ONE HUNDRED TENTH CONGRESS

FIRST SESSION

__________

SEPTEMBER 28, 2007

THE ROLE OF FEDERAL EXECUTIVE BOARDS IN PANDEMIC PREPAREDNESS

__________

OCTOBER 2, 2007

PREPARING THE NATIONAL CAPITAL REGION FOR A PANDEMIC

__________

OCTOBER 4, 2007

FORESTALLING THE COMING PANDEMIC: INFECTIOUS DISEASE SURVEILLANCE
OVERSEAS

__________

Available via http://www.access.gpo.gov/congress/senate

Printed for the use of the Committee on Homeland Security
and Governmental Affairs

----------
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Washington, DC 20402-0001

COMMITTEE ON HOMELAND SECURITY AND GOVERNMENTAL AFFAIRS

JOSEPH I. LIEBERMAN, Connecticut, Chairman
CARL LEVIN, Michigan SUSAN M. COLLINS, Maine
DANIEL K. AKAKA, Hawaii TED STEVENS, Alaska
THOMAS R. CARPER, Delaware GEORGE V. VOINOVICH, Ohio
MARK L. PRYOR, Arkansas NORM COLEMAN, Minnesota
MARY L. LANDRIEU, Louisiana TOM COBURN, Oklahoma
BARACK OBAMA, Illinois PETE V. DOMENICI, New Mexico
CLAIRE McCASKILL, Missouri JOHN WARNER, Virginia
JON TESTER, Montana JOHN E. SUNUNU, New Hampshire

Michael L. Alexander, Staff Director
Brandon L. Milhorn, Minority Staff Director and Chief Counsel
Trina Driessnack Tyrer, Chief Clerk

OVERSIGHT OF GOVERNMENT MANAGEMENT, THE FEDERAL WORKFORCE, AND THE
DISTRICT OF COLUMBIA SUBCOMMITTEE

DANIEL K. AKAKA, Hawaii, Chairman
CARL LEVIN, Michigan GEORGE V. VOINOVICH, Ohio
THOMAS R. CARPER, Delaware TED STEVENS, Alaska
MARK L. PRYOR, Arkansas TOM COBURN, Oklahoma
MARY L. LANDRIEU, Louisiana JOHN WARNER, Virginia

Richard J. Kessler, Staff Director
Lisa Powell, Chief Investigative Counsel
Jodi Lieberman, Professional Staf Member
Thomas Richards, Professional Staff Member
Jennifer A. Hemingway, Minority Staff Director
Theresa Manthripragada, Minority Professional Staff Member
David Cole, Minority Professional Staff Member
Tara Baird, Minority Professional Staff Member
Thomas Bishop, Minority Legislative Aide
Jessica K. Nagasako, Chief Clerk

C O N T E N T S

------
Opening statements:
Page
Senator Akakaiene, State of Maryland, October 2, 2007,
prepared statement............................................. 282

Responses to questions submitted for the October 4, 2007 Record from:

Mr. Gootnick..................................................... 290
Mr. Arthur....................................................... 293
Mr. Smith........................................................ 306
Colonel Erickson................................................. 316
Mr. Hill......................................................... 322
Mr. Flesness..................................................... 350
Dr. Wilson....................................................... 356

Charts submitted for the Record for the October 4, 2007 hearing
by Ray Arthur.................................................. 359
Additional Post-Hearing questions submitted for the
October 2, 2007 Record from Dr. Yeskey......................... 363
GAO Report entitled ``The Federal Workforce, Additional Steps
Needed to Take Advantage of Federal Executive Boards' Ability
to Contribute to Emergency Operation,'' dated May 2007,
GAO�0907�09515, submitted by Bernice Steinhardt.................... 367

THE ROLE OF FEDERAL EXECUTIVE BOARDS IN PANDEMIC PREPAREDNESS

FRIDAY, SEPTEMBER 28, 2007

U.S. Senate,
Subcommittee on Oversight of Government
Management, the Federal Workforce,
and the District of Columbia,

of the Committee on Homeland Security
and Governmental Affairs,
Washington, DC.

The Subcommittee met, pursuant to notice, at 10:03 a.m., in Room SD�09342, Dirksen Senate Office Building

Office of Preparedness and Response, Maryland Department of
Health and Mental Hygiene, State of Maryland, October 2, 2007,
prepared statement............................................. 282
Responses to questions submitted for the October 4, 2007 Record from:
Mr. Gootnick................................................... 290
Mr. Arthur..................................................... 293
Mr. Smith...................................................... 306
Colonel Erickson............................................... 316
Mr. Hill....................................................... 322
Mr. Flesness................................................... 350
Dr. Wilson..................................................... 356

Charts submitted for the Record for the October 4, 2007 hearing
by Ray Arthur.................................................. 359
Additional Post-Hearing questions submitted for the October 2, 2007
Record from Dr. Yeskey......................................... 363
GAO Report entitled ``The Federal Workforce, Additional Steps
Needed to Take Advantage of Federal Executive Boards' Ability
to Contribute to Emergency Operation,'' dated May 2007,
GAO�0907�09515, submitted by Bernice Steinhardt.................... 367

THE ROLE OF FEDERAL EXECUTIVE BOARDS IN PANDEMIC PREPAREDNESS

FRIDAY, SEPTEMBER 28, 2007

U.S. Senate,
Subcommittee on Oversight of Government
Management, the Federal Workforce,
and the District of Columbia,
of the Committee on Homeland Security
and Governmental Affairs,
Washington, DC.

The Subcommittee met, pursuant to notice, at 10:03 a.m., in Room
SD�09342, Dirksen Senate Office Buildiing 2007 hearing........... 261
Background for Octoober 2, 2007 hearing.......................... 267
Background for October 4, 2007 hearing........................... 274
Issac Ajit, M.D., M.P.H., Acting Deputy Director of the Office
of Preparedness and Response, Maryland Department of Health
and Mental Hygiene, State of Maryland, October 2, 2007,
prepared statement............................................. 282

Responses to questions submitted for the October 4, 2007 Record from:
Mr. Gootnick................................................... 290
Mr. Arthur..................................................... 293
Mr. Smith...................................................... 306
Colonel Erickson............................................... 316
Mr. Hill....................................................... 322
Mr. Flesness................................................... 350
Dr. Wilson..................................................... 356

Charts submitted for the Record for the October 4, 2007 hearing by
Ray Arthur..................................................... 359
Additional Post-Hearing questions submitted for the October 2, 2007
Record from Dr. Yeskey......................................... 363
GAO Report entitled ``The Federal Workforce, Additional Steps
Needed to Take Advantage of Federal Executive Boards' Ability
to Contribute to Emergency Operation,'' dated May 2007,
GAO�0907�09515, submitted by Bernice Steinhardt.................... 367

THE ROLE OF FEDERAL EXECUTIVE BOARDS IN PANDEMIC PREPAREDNESS

FRIDAY, SEPTEMBER 28, 2007

U.S. Senate,
Subcommittee on Oversight of Government
Management, the Federal Workforce,
and the District of Columbia,
of the Committee on Homeland Security
and Governmental Affairs,
Washington, DC.

The Subcommittee met, pursuant to notice, at 10:03 a.m., in Room
SD�09342, Dirksen Senate Office Building Maryland, October 2, 2007,
prepared statement............................................. 282

Responses to questions submitted for the October 4, 2007 Record from:

Mr. Gootnick................................................... 290
Mr. Arthur..................................................... 293
Mr. Smith...................................................... 306
Colonel Erickson............................................... 316
Mr. Hill....................................................... 322
Mr. Flesness................................................... 350
Dr. Wilson..................................................... 356

Charts submitted for the Record for the October 4, 2007 hearing by
Ray Arthur..................................................... 359
Additional Post-Hearing questions submitted for the October 2, 2007
Record from Dr. Yeskey......................................... 363
GAO Report entitled ``The Federal Workforce, Additional Steps
Needed to Take Advantage of Federal Executive Boards' Ability to
Contribute to Emergency Operation,'' dated May 2007, GAO�0907�09515,
submitted by Bernice Steinhardt................................ 367

THE ROLE OF FEDERAL EXECUTIVE BOARDS IN PANDEMIC PREPAREDNESS

FRIDAY, SEPTEMBER 28, 2007

U.S. Senate,
Subcommittee on Oversight of Government
Management, the Federal Workforce,
and the District of Columbia,
of the Committee on Homeland Security
and Governmental Affairs,
Washington, DC

The Subcommittee met, pursuant to notice, at 10:03 a.m., in Room SD�09342, Dirksen Senate Office Building 60282

Responses to questions submitted for the October 4, 2007 Record from:

THE ROLE OF FEDERAL EXECUTIVE BOARDS IN PANDEMIC PREPAREDNESS

FRIDAY, SEPTEMBER 28, 2007

U.S. Senate,
Subcommittee on Oversight of Government
Management, the Federal Workforce,
and the District of Columbia,
of the Committee on Homeland Security
and Governmental Affairs,
Washington, DC.

The Subcommittee met, pursuant to notice, at 10:03 a.m., in Room SD�09342, Dirksen Senate Office Building

Office of Preparedness and Response, Maryland Department of Health
and Mental Hygiene, State of Maryland, October 2, 2007, prepared
statement...................................................... 282

Responses to questions submitted for the October 4, 2007 Record from:

THE ROLE OF FEDERAL EXECUTIVE BOARDS IN PANDEMIC PREPAREDNESS

FRIDAY, SEPTEMBER 28, 2007

U.S. Senate,
Subcommittee on Oversight of Government
Management, the Federal Workforce,
and the District of Columbia,
of the Committee on Homeland Security
and Governmental Affairs,
Washington, DC.

The Subcommittee met, pursuant to notice, at 10:03 a.m., in Room SD�09342, Dirksen Senate Office Building

Background for September 28, 2007 hearing........................ 261
Background for October 2, 2007 hearing........................... 267
Background for October 4, 2007 hearing........................... 274
Issac Ajit, M.D., M.P.H., Acting Deputy Director of the Office
of Preparedness and Response, Maryland Department of Health
and Mental Hygiene, State of Maryland, October 2, 2007,
prepared statement............................................. 282

Responses to questions submitted for the October 4, 2007 Record from:

THE ROLE OF FEDERAL EXECUTIVE BOARDS IN PANDEMIC PREPAREDNESS

FRIDAY, SEPTEMBER 28, 2007

U.S. Senate,
Subcommittee on Oversight of Government
Management, the Federal Workforce,
and the District of Columbia,
of the Committee on Homeland Security
and Governmental Affairs,
Washington, DC.

The Subcommittee met, pursuant to notice, at 10:03 a.m., in Room SD�09342, Dirksen Senate Office Building

Prepared statement............................................. 282

Responses to questions submitted for the October 4, 2007 Record from:

Charts submitted for the Record for the October 4, 2007 hearing by
Ray Arthur..................................................... 359
Additional Post-Hearing questions submitted for the October 2, 2007
Record from Dr. Yeskey......................................... 363
GAO Report entitled ``The Federal Workforce, Additional Steps
Needed to Take Advantage of Federal Executive Boards' Ability to
Contribute to Emergency Operation,'' dated May 2007, GAO�0907�09515,
submitted by Bernice Steinhardt................................ 367

THE ROLE OF FEDERAL EXECUTIVE BOARDS IN PANDEMIC PREPAREDNESS

FRIDAY, SEPTEMBER 28, 2007

U.S. Senate,
Subcommittee on Oversight of Government
Management, the Federal Workforce,
and the District of Columbia,
of the Committee on Homeland Security
and Governmental Affairs,
Washington, DC.

The Subcommittee met, pursuant to notice, at 10:03 a.m., in Room SD�09342, Dirksen Senate Office Building

Responses to questions submitted for the October 4, 2007 Record from:

Charts submitted for the Record for the October 4, 2007 hearing by
Ray Arthur..................................................... 359
Additional Post-Hearing questions submitted for the October 2, 2007
Record from Dr. Yeskey......................................... 363
GAO Report entitled ``The Federal Workforce, Additional Steps
Needed to Take Advantage of Federal Executive Boards' Ability to
Contribute to Emergency Operation,'' dated May 2007, GAO�0907�09515,
submitted by Bernice Steinhardt................................ 367

THE ROLE OF FEDERAL EXECUTIVE BOARDS IN PANDEMIC PREPAREDNESS

FRIDAY, SEPTEMBER 28, 2007

U.S. Senate,
Subcommittee on Oversight of Government
Management, the Federal Workforce,
and the District of Columbia,
of the Committee on Homeland Security
and Governmental Affairs,
Washington, DC.

The Subcommittee met, pursuant to notice, at 10:03 a.m., in Room SD�09342, Dirksen Senate Office Building

Senator Coburn............................................... 55
Prepared statement:
Senator Lieberman............................................ 79

WITNESSES
Friday, September 28, 2007

Bernice Steinhardt, Director, Strategy Issues, U.S. Government
Accountability Office (GAO).................................... 3
Kevin E. Mahoney, Associate Director, Human Capital Leadership
and Merit System Accountability Division, Office of Personnel
Management (OPM)............................................... 4
Art Cleaves, Regional Administrator, Region 1, Federal Emergency
Management Agency (FEMA)....................................... 6
Ray Morris, Executive Director, Federal Executive Board of
Minnesota...................................................... 14
Kimberly Ainsworth, Executive Director, Greater Boston Federal
Executive Board................................................ 16
Michael Goin, Executive Director, Cleveland Federal Executive
Board.......................................................... 17

Tuesday, October 2, 2007

Kevin Yeskey, M.D., Deputy Assistant Secretary, and Director,
Office of Preparedness and Emergency Operations, Office of the
Assistant Secretary for Preparedness and Response, U.S.
Department of Health and Human Services........................ 28
Christopher T. Geldart, Director, Office of National Capital
Region Coordination, U.S. Department of Homeland Security...... 30
Robert P. Mauskapf, Director, Emergency Operations, Logistics,
and Planning in Emergency Preparedness and Response Program,
Virginia Department of Health.................................. 32
Darrell L. Darnell, Director, District of Columbia Homeland
Security and Emergency Management Agency....................... 34

Thursday, October 4, 2007

David Gootnick, Director, International Affairs and Trade, U.S.
Government Accountability Office............................... 52
Ray Arthur, Ph.D., Director, Global Disease Detection Operations
Center, Centers for Disease Control and Prevention, U.S.
Department of Health and Human Services........................ 54
Kimothy Smith, D.V.M., Ph.D., Acting Director, National
Biosurveillance Integration Center, Chief Scientist, Office of
Health Affairs, U.S. Department of Homeland Security........... 56
Colonel Ralph L. Erickson, M.D., DrPH., Director, Department of
Defense Global Emerging Infections Surveillance and Response
System (DOD-GEIS), U.S. Department of Defense.................. 57
Kent R. Hill, Ph.D., Assistant Administrator for Global Health,
U.S. Agency for International Development...................... 59
Nathan R. Flesness, Executive Director, International Species
Information System (ISIS)...................................... 70
Daniel A. Janies, Ph.D., Assistant Professor, Department of
Biomedical Informatics, Ohio State University Medical Center... 73
James M. Wilson V, M.D., Director, Division of Integrated
Biodefense, Imaging Science and Information Systems (ISIS)
Center, Georgetown University.................................. 74

Alphabetical List of Witnesses

Ainsworth, Kimberly:
Testimony.................................................... 16
Prepared statement with attachments.......................... 109
Arthur, Ray, Ph.D.:
Testimony.................................................... 54
Prepared statement........................................... 203
Cleaves, Art:
Testimony.................................................... 6
Prepared statement........................................... 98
Darnell, Darrell L.:
Testimony.................................................... 34
Prepared statement........................................... 176
Erickson, Colonel Ralph L., M.D., DrPH.:
Testimony.................................................... 57
Prepared statement........................................... 228
Flesness, Nathan R.:
Testimony.................................................... 70
Prepared statement........................................... 246
Geldart, Christopher T.:
Testimony.................................................... 30
Prepared statement........................................... 160
Goin, Michael:
Testimony.................................................... 17
Prepared statement with attachments.......................... 142
Gootnick, David:
Testimony.................................................... 52
Prepared statement........................................... 184
Hill, Kent R., Ph.D.,:
Testimony.................................................... 59
Prepared statement........................................... 238
Janies, Daniel A., Ph.D.:
Testimony.................................................... 73
Prepared statement........................................... 252
Mahoney, Kevin E.:
Testimony.................................................... 4
Prepared statement........................................... 94
Mauskapf, Robert P.:
Testimony.................................................... 32
Prepared statement........................................... 166
Morris, Ray:
Testimony.................................................... 14
Prepared statement........................................... 105
Smith, Kimothy, D.V.M., Ph.D.:
Testimony.................................................... 56
Prepared statement........................................... 220
Steinhardt, Bernice:
Testimony.................................................... 3
Prepared statement........................................... 80
Wilson, James M. V, M.D.:
Testimony.................................................... 74
Prepared statement........................................... 254
Yeskey, Kevin, M.D.:
Testimony.................................................... 28
Prepared statement........................................... 150

APPENDIX

Background for September 28, 2007 hearing........................ 261
Background for Octoober 2, 2007 hearing.......................... 267
Background for October 4, 2007 hearing........................... 274
Issac Ajit, M.D., M.P.H., Acting Deputy Director of the Office of
Preparedness and Response, Maryland Department of Health and
Mental Hygiene, State of Maryland, October 2, 2007, prepared
statement...................................................... 282
Responses to questions submitted for the October 4, 2007 Record
from:
Mr. Gootnick................................................. 290
Mr. Arthur................................................... 293
Mr. Smith.................................................... 306
Colonel Erickson............................................. 316
Mr. Hill..................................................... 322
Mr. Flesness................................................. 350
Dr. Wilson................................................... 356
Charts submitted for the Record for the October 4, 2007 hearing
by Ray Arthur.................................................. 359
Additional Post-Hearing questions submitted for the October 2,
2007 Record from Dr. Yeskey.................................... 363
GAO Report entitled ``The Federal Workforce, Additional Steps
Needed to Take Advantage of Federal Executive Boards' Ability
to Contribute to Emergency Operation,'' dated May 2007, GAO-07-
515, submitted by Bernice Steinhardt........................... 367

THE ROLE OF FEDERAL EXECUTIVE BOARDS IN PANDEMIC PREPAREDNESS

----------

FRIDAY, SEPTEMBER 28, 2007

U.S. Senate,
Subcommittee on Oversight of Government
Management, the Federal Workforce,
and the District of Columbia,
of the Committee on Homeland Security
and Governmental Affairs,
Washington, DC.
The Subcommittee met, pursuant to notice, at 10:03 a.m., in
Room SD-342, Dirksen Senate Office Building, Hon. Daniel K.
Akaka, Chairman of the Subcommittee, presiding.
Present: Senator Akaka.

OPENING STATEMENT OF SENATOR AKAKA

Senator Akaka. This hearing will come to order.
I would like to thank you all for joining us for this
hearing on the role of Federal Executive Boards in the
preparation and continuity of operations in the event of a
pandemic influenza outbreak or other emergency.
Although we spend billions of dollars preparing the
National Capital Region--the heart of our Federal Government--
for emergencies, outbreaks, and potential terrorist attacks,
more than 85 percent of the Federal workforce is employed
outside of the Washington, DC area. Next week, we will hear
about pandemic preparedness in the NCR and the global
surveillance of tracking infectious diseases.
Today, we begin to look at the preparation of the Federal
workforce outside the Nation's capital and the support that
FEBs can offer those communities.
President Kennedy issued a directive in 1961 to create FEBs
and allow the heads of Federal agencies in 10 regions around
the country to come together to address human capital and
emergency issues in those Federal communities. There are now,
can you believe it, 28 boards in 20 States, including Hawaii.
We invited the Executive Director of the Honolulu-Pacific
Federal Executive Board, Ms. Gloria Uyehara, to be present and
to give her testimony today, but regretfully she was unable to
make the long trip.
FEBs are a quasi agency with no institutionalized structure
and no dedicated source of funding. OPM oversees the FEBs, but
the staff is usually employed by a local agency detailee. They
do not receive specific appropriated funds. Some have an
executive director, some have no permanent staff at all. Each
one of the 28 FEBs seems to have its own funding and operating
structure.
A Government Accountability Office report concluded in the
year 2004 that Federal Executive Boards could play a greater
role in the coordination of emergency preparedness and
response. Their latest report released in May of this year
reaches the same conclusion with a particular focus on pandemic
influenza preparedness.
GAO recommends the development of a strategic plan for FEBs
to support emergency operations, including dedicated funding
and performance measurements. I understand that OPM has been
working on a strategic plan and consulting with the Federal
Emergency Management Agency. I look forward to hearing more
about these efforts.
Public health experts at the World Health Organization
(WHO) believe that the world is due for a pandemic influenza
outbreak. In the past 100 years, pandemic influenza has killed
43 million people around the world. Most recently, the Hong
Kong flu killed 2 million people in 1968. The Centers for
Disease Control and Prevention estimate that a flu pandemic
could kill between 2 million and 7.4 million people worldwide.
Today, the threat of the avian influenza, or the H5N1
virus, continues to rise. WHO reports that there have been 328
cases of infections in humans from South East Asia across the
continent into Africa and the edges of Europe since 2003. Of
those cases, 200 humans have died. While most cases of human
infection of avian influenza are through contact with live
poultry, in late August a group of doctors confirmed for the
first time the spread of the H5N1 virus from human to human in
Indonesia.
There are treatments available, but there are also distinct
challenges to emergency response for pandemic outbreak. Unlike
one-time disasters, pandemics can last for an extended period
of time, come in waves, and infect populations across a broad
geographic area. They require the coordination of emergency
response teams with health officials and community groups. Even
more difficult, they can bring up sensitive issues of social
distancing and treatment prioritization.
I do not think that we will be able to address all of these
issues at this hearing. I do, however, expect that our
witnesses will shed light on a few fundamental questions.
Should FEBs play a role in responding to a single emergency
event or pandemic influenza outbreak? And if so, what is their
capacity to play a significant role?
From what I know about this organization, I think that
group can really make a difference.
I look forward to hearing from our witnesses on the
establishment of emergency response, continuity of operations,
and pandemic preparedness and response plans in relation to
Federal Executive Boards.
So I want to say welcome again to our panel and to
introduce Bernice Steinhardt, Director of Strategic Issues,
Government Accountability Office; Kevin Mahoney, Associate
Director, Human Capital Leadership and Merit System
Accountability, Office of Personnel Management; and Art
Cleaves, Region 1 Administrator, Federal Emergency Management
Agency.
Our Subcommittee rules require that all witnesses testify
under oath. Therefore, I ask all of our witnesses to stand and
raise your right hand and take this oath.
Do you solemnly swear that the testimony you are about to
give this Subcommittee will be the truth, the whole truth, and
nothing but the truth, so help you, God?
Ms. Steinhardt. I do.
Mr. Mahoney. I do.
Mr. Cleaves. I do.
Senator Akaka. Let it be noted for the record that the
witnesses answered in the affirmative
Welcome again, and before we begin, I want all of you to
know that although your oral statement is limited to 5 minutes,
your full written statements will be included in the record. So
Ms. Steinhardt, will you please proceed with your statement?

TESTIMONY OF BERNICE STEINHARDT,\1\ DIRECTOR STRATEGIC ISSUES,
GOVERNMENT ACCOUNTABILITY OFFICE

Ms. Steinhardt. Thank you very much, Mr. Chairman. We
appreciate the opportunity to be here today to talk about the
results of our review of Federal Executive Boards (FEBs) and
their ability to contribute to the Nation's efforts to prepare
for a potential flu pandemic.
---------------------------------------------------------------------------
\1\ The prepared statement of Mr. Steinhardt appears in the
Appendix on page 80.
---------------------------------------------------------------------------
The FEBs, as you pointed out, are unique entities in the
Federal Government. Many of the challenges the country faces,
and particularly those having to do with homeland security and
emergency preparedness, can only be addressed through the
collaborative efforts of networks of organizations working
horizontally, across many Federal agencies, as well as among
State and local governments and the private and nonprofit
sectors. The FEBs are this kind of network.
They operate in 28 cities and States, and consequently are
uniquely positioned to improve the coordination of emergency
preparedness efforts outside of Washington, DC, which, as you
pointed out, is where the vast majority of Federal employees
work.
Given the nature of a pandemic flu, this capability could
be particularly valuable. Because a pandemic flu is likely to
last for months and will occur in many parts of the country at
the same time, the center of gravity of the pandemic response
will be in communities. As a result, planning for a pandemic
will have to be integrated across all levels of government and
the private sector as well, and it will have to be sustained
over a long time.
Let me turn now to some of the findings of our study. At
the time of our review, all 14 Boards in our study were engaged
in some type of emergency planning. All of them had an
emergency communications network, an emergency preparedness
council in place, and all of them had some degree of
involvement with State and local officials in their emergency
activities. Many of them, were also playing an active role in
pandemic planning from sponsoring briefings to coordinating
pandemic exercises involving numerous government and
nongovernment organizations.
Even looking ahead to a possible response role for them
during a pandemic, FEBs have the potential to broaden the
situational awareness of their member agencies and to provide a
forum to inform their decisions, much like what they now do
during inclement weather conditions.
But the FEBs face a number of challenges in trying to live
up to this potential. First, the Boards are not included in any
national emergency plans, which means that their value in
emergency support is often overlooked by Federal agencies who
are unfamiliar with their capabilities. By including the Boards
in emergency management plans, the role of the FEBs and their
contribution in emergencies involving the Federal workforce
could be much better communicated.
Second, it will be difficult to provide consistent levels
of emergency support services across the country given the
variations in the capabilities of the FEBs. The Boards, as you
pointed out, have no Congressional charter, and receive no
Congressional appropriation. Instead they rely on voluntary
contributions from their member agencies, including staff,
which are typically just an executive director and an
assistant. As a result, funding for the FEBs has been
inconsistent which, in turn, creates uncertainty for the Boards
in planning and committing to provide emergency support
services. In fact, some Federal agencies that have voluntarily
funded FEB positions in the past have begun to withdraw their
funding support.
Our report outlines several actions to address these
challenges. First, we recommended that OPM work with FEMA and
the Department of Homeland Security to formally define the FEB
role in emergency planning and response. We also recommended
that OPM, as part of its strategic planning efforts, develop a
proposal for an alternative to the current voluntary
contribution mechanism that would address the uncertainty of
funding for the Boards.
In closing, Mr. Chairman, I want to underscore that the
FEBs today offer us a potentially--and I want to underline
potentially--important mechanism to support pandemic planning
and the Federal workforce. That potential still remains to be
realized in many cases where the Boards' capacity still needs
to be developed.
On the other hand, for an event like a pandemic flu, FEBs
are tailor-made for working across agency and government lines.
As one FEMA official told us, if they did not exist, we would
have to create them. With that, I will conclude my statement
and be happy to answer any questions. Thank you.
Senator Akaka. Thank you very much for your statement. Mr.
Mahoney.

TESTIMONY OF KEVIN E. MAHONEY,\1\ ASSOCIATE DIRECTOR, HUMAN
CAPITAL LEADERSHIP AND MERIT SYSTEM ACCOUNTABILITY DIVISION,
OFFICE OF PERSONNEL MANAGEMENT

Mr. Mahoney. Good morning, Mr. Chairman, I am pleased to be
here on behalf of our Director, Linda Springer, to discuss the
role of the Federal Executive Boards and how they can assist
with pandemic preparedness and other Federal emergency planning
and response efforts.
---------------------------------------------------------------------------
\1\ The prepared statement of Mr. Mahoney appears in the Appendix
on page 94.
---------------------------------------------------------------------------
We appreciate that this Subcommittee has recognized the
value of these Bards and we share your commitment to increasing
their effectiveness.
As you mentioned, the Presidential Directive established
the Boards, and the Boards were directed to work on interagency
regional cooperation and to establish liaison with State and
local governments. The contribution these Boards can make
towards emergency preparedness and assistance for Federal
employees and their families and for all Americans have become
more evident as a result of the terrorist attacks of September
11, 2001 and Hurricane Katrina in 2005. The National Strategy
for Pandemic Influenza, issued by President Bush in 2005, also
provides opportunities for Federal Executive Boards to play a
critical role, which I will discuss further in my testimony.
In close collaboration with the Chairs and the Executive
Directors of the Federal Executive Boards, OPM has established
two primary lines of business: Emergency preparedness, security
and employee safety; and human capital preparedness. In
addition to these lines of business, the Boards are also
expected to focus on establishing communication channels that
can help build understanding and teamwork among Federal
agencies in the field. The experiences of September 11, 2001
and Hurricane Katrina have demonstrated these relationships
need to be in place before an emergency occurs.
While the Federal Government received criticism for its
response to Hurricane Katrina, there were many successes that
have not yet received the same level of attention. In
particular, I wanted to acknowledge today the key role that was
played by the New Orleans Federal Executive Board and its
Executive Director, Kathy Barre, and just underscore some of
the things they did. The Board coordinated with OPM and FEMA to
collect information, and communicated issues of concern
regarding the Federal workforce from Federal agencies at the
local level.
The Board also facilitated sharing of Federal workforce
information to and from Washington by organizing
teleconferences with FEMA and OPM and other agencies.
Finally, the Board helped to identify both the needs and
the status of local Federal workers and their families to make
sure that they were part of FEMA's response activities.
Two more recent events have really brought home the
importance of these Boards and the relationships and
communication channels they bring to the table at the Federal/
regional level during emergencies. The first is the most recent
Minnesota bridge collapse, and you will hear more from Ray
Morris later today about that event. The second was an event of
tuberculosis with a HUD employee in New York City. In both of
these cases, the Board, through its relationships with State,
local, and Federal agencies, was able to gather information,
communicate information, and assure the safety of Federal
employees. Quick action, especially in New York, alleviated
many employee concerns about tuberculosis and how tuberculosis
can sometimes be spread.
Director Springer and all of us at OPM take very seriously
the direction that President Bush has assigned to our agency
with respect to pandemic preparedness. To help departments and
agencies mitigate the effects of a pandemic event, OPM has
developed human resource policies and mechanics to assure
safety of the Federal workforce and continuity of Federal
operations. We have provided agencies with training,
information for their human resources, and emergency
preparedness personnel. We have also conducted town hall
meetings with the Department of Health and Human Services to
educate Federal employees on pandemic preparedness.
Mr. Chairman, the recent report you requested from the
Government Accountability Office concerning Federal Executive
Boards and their emergency operations role acknowledges much of
what I have described in my statement. The report also makes
four recommendations that I would like to address briefly.
First, GAO recommended that OPM work with FEMA to develop a
memorandum of understanding that formally defines the role of
the FEBs in emergency planning and response. My staff has met
with FEMA and later in October, I will also meet with Dennis
Schrader, who is the Deputy Administrator at FEMA, to finalize
an MOU. We have made good progress in that area.
Second, GAO recommended that OPM initiate discussions with
Homeland Security and other stakeholders. We have met with the
White House Homeland Security Council staff and we are
integrating the Federal Boards into planning.
In conclusion, Mr. Chairman, I would like to say that OPM
is proud of the accomplishments of the Federal Executive
Boards, especially with planning and response to emergency
situations, where lives are at stake and government services
are critical. We will continue to work with the Boards and
agencies to better prepare the Federal workforce at the
regional level for a possible pandemic influenza or other
emergency event.
I am happy to answer any of your questions. Thank you.
Senator Akaka. Thank you very much, Mr. Mahoney. And now,
Mr. Cleaves, please proceed with your testimony.

TESTIMONY OF ART CLEAVES,\1\ REGIONAL ADMINISTRATOR, REGION 1,
FEDERAL EMERGENCY MANAGEMENT AGENCY

Mr. Cleaves. Mr. Chairman, thank you very much for inviting
me to appear before your Subcommittee today and highlight our
activities with Greater Boston Federal Executive Board and to
underscore our strong working relationship.
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\1\ The prepared statement of Mr. Cleaves appears in the Appendix
on page 98.
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Mr. Paulison laid out a vision for a new FEMA that
integrates and incorporates missions assigned to FEMA by the
Post-Katrina Emergency Management Reform Act of 2006. An
important part of that vision is an enhanced role in regional
preparedness to include the Federal Executive Boards.
In the new FEMA, preparedness activities will be integrated
into a regional focus designed to serve the needs for States
and local communities. FEMA regions will become networking
organizations, instrumental in the development of a seamless
connection with all of our partners, Federal, State, tribal,
local, homeland security advisors, emergency management
directors, and the private sector, as well. This is going to
result in a full preparedness strategy carrying awareness
through the State to the individual communities. This awareness
will become embedded through training and exercising from a
local level to the Federal level.
Our approach and preparedness is all hazard approach,
including terrorist events, other manmade events, natural
disasters and, of course, including a pandemic.
The Federal Executive Boards and FEMA share a common role
as coordinating elements. The Federal Executive Boards are a
critical part of preparedness in response, recovery,
mitigation, and in particular continuity of operations and
continuity of government.
The Greater Boston Federal Executive Board is an integral
part of our preparedness and our preparedness strategic
planning. Their proven ability to effectively coordinate with
all Federal organizations makes the FEB a key factor in
preparing for a potential pandemic.
Because of New England's compact geographical size, we
maintain a very close working relationship with the States and
also the Federal organizations. And maintaining this
relationship is greatly facilitated by the effectiveness of the
Executive Director of the Greater Boston Federal Executive
Board, Kim Ainsworth, and she will be testifying on the second
panel today.
FEMA Region 1 is going to be coordinating a regionwide
pandemic exercise during the next quarter. This is the first
exercise of this size, scope or magnitude in New England. The
goal is to bring Federal/State partners together to review the
issues that present themselves and to better understand the
roles and responsibilities of government during any pandemic.
The Federal Executive Boards play an important role in pandemic
preparedness, acting as a coordinating agency for the Federal
departments who will have the lead in the pandemic outbreak.
These departments include Department of Health and Human
Services, as well as the Centers for Disease Control. Those are
key components during this response element. But because of the
nature of a pandemic and its potential to affect large
populations, the FEBs' ability to coordinate with all the
Federal agencies in a timely manner is essential.
The FEB and its relationship building capability can be a
key resource in the event of a pandemic. Let me underscore just
a couple very quickly, of coordination elements that they can
do. I mentioned the coordination between agencies when social
distance is required, and that is all agencies in the Federal
Government.
The FEB is also a conduit for resource support during any
response operation. And the nature of a pandemic will severely
reduce the workforce. The greatest concern of government, and
in private sector as well, is the numbers of personnel. The FEB
is postured to reach all Federal agencies, and give us
additional response personnel that we might need in the
response phase of a pandemic.
The FEB can and should play a major role in pandemic
preparedness and response. By pre-identifying unique
capabilities that exist within the FEB and by establishing
roles and responsibilities it will undertake during a pandemic
that FEB can engage from the outset to enhance response effort
and integrate all Federal agencies.
The FEB has also been engaged in the area of continuity of
operations and continuity of government in Region 1 by
assisting coordination of training between all member agencies.
As I previously indicated to you, we are planning a major
pandemic influenza exercise in the Region in December. This
exercise is going to solicit active participation from all the
Federal agencies and the Greater Boston Federal Executive Board
will again play an integral role in part of that coordination.
This exercise is going to provide an opportunity for all of
the Federal agencies to gain a more accurate picture of their
continuity of operations and their continuity of government
posture. Overall, we can see very quickly that the Federal
Executive Boards are an integral part of the fabric of the new
FEMA.
In conclusion, I would like to thank you again for the
opportunity to give you this testimony today and I look forward
to any questions. Thank you.
Senator Akaka. Thank you very much, Mr. Cleaves.
I want to thank all of you for your testimony. I must tell
you that I am delighted to hear what you have said here.
The GAO report says that FEBs can be a valuable asset
because of its informal relationships--highlights the
importance of informal relationships with governmental and
nonprofit partners. GAO recommended that FEBs' role be
formalized. So what I am interested in, what are your thoughts
in the recommendation by the GAO that FEBs' role be formalized?
Ms. Steinhardt.
Ms. Steinhardt. Well, it is wonderful that the FEBs have
these relationships with other organizations at other levels of
government now and have taken, in some cases, an active role in
working with them on emergency preparedness activities. But it
is not enough to do this on an informal basis. Some of the
people we talked to were not familiar with the fact that they
had a role to play and so they are an underutilized resource in
some instances.
But beyond that, it is important in an emergency response
for everyone to understand what role they are going to play in
advance of the emergency. Certainly, we learned this lesson in
Hurricane Katrina and other national disasters. Those roles
have to be clearly identified beforehand. And so it is
important, if FEBs are going to play a role in planning and
preparedness and response, that they be formally identified.
Senator Akaka. So your thoughts are that you are on the
side of formalizing that?
Ms. Steinhardt. Absolutely. For that reason we recommended
that there be some formal agreement between OPM and FEMA to
formalize that role and to explore the possibility of including
the FEBs actually in the National Response Plan or other
national plans.
Senator Akaka. Thank you. Mr. Mahoney.
Mr. Mahoney. We agree. The role of the FEBs is critical to
any response to an emergency that might occur and that their
role should be formalized. As I mentioned earlier, we are and
have been meeting with FEMA to establish an MOU that would
formalize the FEBs role and any response to an event. In
addition, through the creation of our strategic plan with the
FEBs, we are moving in a direction where the FEBs will focus,
hopefully, about 50 percent of their time on emergency
preparedness.
We are taking steps through both our own work with the FEBs
as well as our work with FEMA to formalize a role for the FEB
in any emergency event.
Therefore, we do agree with GAO that there should be a
process in place that identifies the role of the FEB.
Senator Akaka. Thank you. Mr. Cleaves.
Mr. Cleaves. Mr. Chairman, I could not agree more
thoroughly with that.
Mr. Mahoney mentioned that the MOU is now being formulated
between FEMA and the FEBs, and that will be a critical part
both in the preparedness area and in a response phase, as well.
If all organizations understand those roles and
responsibilities, we can multiply the horsepower and get that
much more preparedness done and understand roles and response
and recovery. It is really part of the national response
framework, as well.
So we could not agree more.
Senator Akaka. Is there a chance that the informal
relationships could be threatened by formalizing those
relationships? Ms. Steinhardt.
Ms. Steinhardt. I do not think so. I think the informal
relationships, the relationships among people, are vital. That
is where the relationships occur. But I think it is equally
important for those relationships to be understood and
formalized so that people are very clear about what they are
expected to do, both in advance of a national emergency or a
local emergency as well as during an emergency. Having clear
expectations is critical.
Senator Akaka. Mr. Mahoney.
Mr. Mahoney. Mr. Chairman, I do not think you can
underscore enough the importance of the informal relationships
that exist at the local level. I had a first-hand glimpse of
this in August when the Minnesota bridge collapsed and Ray
Morris, who was in Washington at the time, attending our annual
FEB conference, was able to communicate with contacts at the
State, local, and national levels. I am sure he will talk more
about that in his testimony.
It was an opportunity for me to watch how these informal
networks can come together so quickly because people already
know each other. They do not have to, at the site of an
emergency, introduce each other and get to know who does what,
it has already been established.
The formalizing process, I think, just makes it easier for
everybody in Washington to understand how to communicate with
the FEBs and what channels to use so that the informal process
really then begins to take shape at the site level.
I agree with Ms. Steinhardt, I do not see any danger in
formalizing this.
Senator Akaka. Mr. Cleaves.
Mr. Cleaves. I also agree with that. I think formalizing
it, again, will multiply the efforts.
So many times in an informal relationship there is a
crossover, there is a duplication of effort. When you formalize
it then, in fact, you will get more effort accomplished in the
end, a much better way to do it.
Senator Akaka. Mr. Cleaves, are there similar organizations
to FEBs in the State, local, or private sector that play a
formal or informal role in responding to an emergency or
pandemic outbreak?
Mr. Cleaves. Yes, Mr. Chairman. The first one that comes to
mind is the volunteer organizations active during disasters,
all volunteer groups that come forward. So there are many
organizations that respond during that phase.
One of the things that I captured in my notes here is that
training and exercise and then, in fact, I could tell you, in
our case, the Federal Executive Board in the Greater Boston
area is an integral part of what we do. It is an organization
that can reach all of the Federal agencies, not just the major
responders, but all organizations. So it is a critical piece of
what we do. But there are many organizations that we try to
have memorandums of understanding with so again it is not a
duplication of effort but a better, broader preparedness
effort.
Senator Akaka. Ms. Steinhardt, a pandemic outbreak could
last a long time.
Ms. Steinhardt. Right.
Senator Akaka. Come in waves, as I said, and happen over a
broad geographic region, which would make continuity of
operations planning especially challenging. What strengths do
FEBs have for dealing with emergency response for an event
unfolding over an extended time and over a geographic area?
Ms. Steinhardt. That is an excellent question. One of the
strengths of the FEBs is that they have an established network
of Federal officials in their location. Because a pandemic, as
I said in my statement, will last for a long time and occur all
over the country, unlike other kinds of disasters where the
Federal Government can mobilize a lot of resources to a single
location, communities are going to have to deal with a pandemic
flu largely on their own. They are going to have to do--as you
say, they are going to do it over an extended period of time.
So it is going to involve a sustained level of leadership.
And because FEBs are in those communities, because they
have established relationships, because they represent the
largest Federal agencies, they can bring that kind of sustained
leadership over an extended period of time.
Senator Akaka. OPM is in the process of developing a
national strategic plan for FEBs with input from FEMA. For some
FEBs the guidance will be welcome direction, and for others it
could read outside the scope of their capacity. Given the
differences among FEBs around the country, how are you ensuring
that strategic plans reflect the capacity of each FEB? Mr.
Mahoney.
Mr. Mahoney. Mr. Chairman, in OPM's review of the FEBs one
of the things we are looking at is the question of whether FEBs
are staffed appropriately by the size of the population they
serve, which I think gets to the heart of your question. We
have not reached any firm conclusions yet. Most FEBs operate on
a model with an Executive Director and an Assistant. We are not
sure if that model holds for an area like Los Angeles, which
has a large population.
We are in the process of evaluating what level of staffing
is appropriate.
As you know, the Board itself comprises the most senior
persons in agencies located within the FEB's geographical area,
and therefore Board size varies. But, the support of the Board
is critical, and I think as we move further into emergency
preparedness, roles having the FEB properly staffed to carry
out those functions is going to be an important issue on which
OPM should work.
Senator Akaka. Mr. Cleaves.
Mr. Cleaves. We are involving the Greater Boston Federal
Executive Board in our strategic planning starting this year.
And I do not think in the past we have done it as thoroughly
and deeply as we are attending to this year. We have already a
very strong working relationship. But we are going to involve
them early in the preparedness portions, the planning portions,
and then intricately in the exercises.
As I mentioned, for those Federal organizations that do not
normally respond to a major event, there are all the other
agencies that will need that coordination. That is a big role
for the Federal Executive Board to take on.
We have also made working space in our Boston office for
Ms. Ainsworth so she can become a closer part of knowing what
we do on a day-to-day basis. So that is going to be a more
integral working relationship than there has been before.
Ms. Steinhardt. Mr. Chairman, if I can add to Mr. Mahoney's
comments particularly, one of the issues we touched on in our
report dealing with capability of the FEBs and their varied
capability had to do with performance expectations for the
executive directors. Currently, they are employees of a host
agency in each of the regions. In some instances their
performances expectations and their performance is assessed by
that host agency. In some cases, it is by the chair of the
Federal Executive Board. In some cases, OPM plays a part in
fact, and in some cases it does not.
And so one of our recommendations was for OPM to develop a
more consistent set of performance expectations for the
executive directors. We think that will help a lot.
Senator Akaka. This question will be for OPM. When can we
expect to see the strategic plan? And how are you incorporating
GAO's recommendation?
Mr. Mahoney. Well, to add to Ms. Steinhardt's comments, we
very much agreed that there should be a common set of
performance metrics for the FEBs. Earlier in your comments, you
mentioned the funding issue. We think it is important, as we
ask agencies to fund the FEBs, to be able to demonstrate what
the FEBs will accomplish. Therefore, part of our review in the
strategic plan is to work with the Executive directors and the
Board chairs to develop a set of performance metrics on which
we can all agree.
We think, with relationship to the strategic plan, we
should have something finalized this coming winter. We have
been working on it. As you know, there are 28 separate
locations and communication and coordination take a little
time. We think by this winter we should have a finalized
strategic plan.
Senator Akaka. Mr. Mahoney, it is my understanding that in
the event of a pandemic outbreak local health departments may
not have the capacity to treat the critical personnel at
Federal agencies that must be at work. Some Federal agencies
are already identifying critical personnel and stockpiling
medication. Have you begun to look at how agencies are handling
this issue in the field? And how can FEBs help in this effort?
Mr. Mahoney. Mr. Chairman, in a number of cities the FEBs
are working with State and local authorities to identify the
appropriate distribution of vaccines in the event of an
emergency and I guess the appropriate order in which vaccines
should be delivered. Some of this work is still in the early
stages, but we are encouraging all of the FEBs to get more
involved in this particular process because we see it as key
not only for the Federal population, but also for the people
locally in those areas. We are working toward a program with
respect to vaccine distribution.
Senator Akaka. Mr. Cleaves, the testimony presented today
shows some of the ways that FEBs can support the overall
response efforts in the event of a pandemic and other
emergency. What do you see as the realistic responsibilities
that should be given to FEBs in the event of an emergency or
pandemic?
Mr. Cleaves. I think the two areas that I mentioned earlier
is the coordination that they provide. We have got a proven
track record in the Greater Boston area of Ms. Ainsworth being
able to coordinate with all of the Federal agencies very
effectively during a pandemic. There is going to be a very
reduced workforce so it is going to be critical for that.
The second one I mentioned in the testimony is the ability
for the FEB to identify additional workers in that response
phase. We have a very deliberate and defined action that we
take, whether it is a hurricane coming into the region or
whether it is a pandemic, that we move our response
coordination center out in Maynard, Massachusetts. The FEB can
communicate with all Federal agencies what our strategy will be
and then also what their response objectives can be during a
pandemic.
Senator Akaka. Mr. Mahoney and Ms. Steinhardt, FEBs do not
conduct performance reviews, provide pay adjustments, or
provide bonuses to participants. Their employing agencies do
that. This presents challenges for establishing performance
measures. When talking about establishing performance standards
for FEBs, how do you recommend establishing them? And who
should be responsible for evaluating them? And whose
performance should be measured?
Ms. Steinhardt.
Ms. Steinhardt. An excellent question and one that is, I
think, very important. We recommended that this be part of the
strategic planning effort that is now underway, OPM working
with the Federal Executive Boards. To the extent that OPM is
setting expectations for the FEBs for human capital, in the
area of human capital management and in emergency preparedness,
then OPM needs to be involved in setting those standards so
that there is some consistency across the country.
At the same time though, it is important to recognize that
one of the strengths of the FEBs is the fact that they are
local, that they are responsive to their local conditions, to
their regional perspective. So there needs to be some
collaborative effort, I think, between OPM and the FEBs and the
members of the FEB on what those standards should be.
Senator Akaka. Mr. Mahoney.
Mr. Mahoney. As I said earlier, we are in the process of
working on a common set of performance measures. It is
problematic that the FEB directors report to a variety of
different agencies. But I think the common denominator is that
all of those agencies are interested in employee security and
human capital readiness.
As we go about looking at how to develop agreed-upon
standards, I think we will work very closely with the agencies
that support the FEBs and get their buy-in on a set of plans
that both support the FEBs and support their own agency needs
with respect to employee security and human capital readiness.
Senator Akaka. As I mentioned here, I was asking your
thoughts on any recommendations on how to establish this and
also who should be evaluating. Of course, OPM being the
personnel, could be. The other question was who should you
measure? But this is something that we need to really think
about.
Mr. Mahoney, OPM has oversight of the operations of FEB.
But most FEB operations are directed by the FEB chairman and
the executive director. All participation by agency heads is
voluntary. That is the setup. If we place greater emphasis on
FEBs in participating in emergency response plans, who
ultimately would be accountable for their efforts?
Mr. Mahoney. Mr. Chairman, we do have oversight over the
FEBs and we have established, as I mentioned, these two lines
of businesses because we feel that they are most important in
the ongoing collaboration and coordination in Federal agencies
outside of Washington, DC. We take very seriously our role in
overseeing how this is accomplished.
As we have discussed here this morning, this is a very
localized organization which has a national responsibility. We
have to continue to work with the local agencies as well as
setting standards we think the agencies need to live up to.
Ultimately, each agency has to evaluate how their FEBs are
performing. OPM plans to have a significant role in that
discussion.
Senator Akaka. I want to thank you all for your responses.
It is very evident that coordination, collaboration, working
together, trying to keep it as a formalized organization
informally. And so this is a challenge. I am glad that you are
thinking about this and we look forward to us continuing to
work on this because finally the mission is to deliver in
emergencies. And unless, as you mentioned, we plan beforehand
we will not do as well.
I would tell you after 20 hearings on Hurricane Katrina we
have learned a lot and so much has to be done. I tell you one
of the problems with Hurricane Katrina that many people, I
think, miss what I caught in the 20 hearings was personnel, and
that there were positions that were vacant. So therefore, it
could not be carried forward.
So all of these need to be part of the strategic planning
for the future.
I appreciate your thoughts on this and was glad, as I said
at the beginning, to what you have said about bringing it
together and the importance of working from the regional level
all the way up through the agencies. But we have to communicate
and take all advantage of communicating. And also, the other
part to that as we are working here is that we need to make
good use of our information technology. That technology is
building fast and we need to use it well.
So again, thank you so much for your responses and I really
appreciate it.
Let me call panel two forward. The witnesses are Ray
Morris, Executive Director of the Federal Executive Board of
Minnesota; Kimberly Ainsworth, Executive Director of the
Greater Boston Federal Executive Board; and Michael Goin,
Executive Director of the Cleveland Federal Executive Board.
Our Subcommittee rules, as I mentioned earlier, require
that all witnesses testify under oath. Therefore, I ask all of
the witnesses to please rise and raise your right hand.
Do you solemnly swear that the testimony you are about to
give this Subcommittee is the truth, the whole truth, and
nothing but the truth, so help you, God?
Mr. Morris. I do.
Ms. Ainsworth. I do.
Mr. Goin. I do.
Senator Akaka. Let it be noted for the record that the
witnesses answered in the affirmative
Again, I want to welcome you to this Subcommittee. As a
reminder, your oral statements are limited to 5 minutes but
your full written statements will be included in the record. So
Mr. Morris, will you please proceed with your statement.

TESTIMONY OF RAY MORRIS,\1\ EXECUTIVE DIRECTOR, FEDERAL
EXECUTIVE BOARD OF MINNESOTA

Mr. Morris. Good morning, Mr. Chairman. I am Ray Morris,
Executive Director of the Minnesota Federal Executive Board.
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\1\ The prepared statement of Mr. Morris appears in the Appendix on
page 105.
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As a FEB director, I am responsible for the coordination of
over 120 Federal Government agencies within Minnesota and
intergovernmental relations with State and local government.
There is a great need among FEB directors to have our
current work and function reflected in Federal emergency
planning documents like the National Response Framework. This
action will enhance our effectiveness and credibility for the
work that we are doing with Federal, State and local government
agencies. We fill a niche that the FBI, FEMA, and the military
do not focus on, the Federal workforce in field areas.
Established in 1961, FEBs had our roots in the cold wars,
ensuring the continuity of government in the field, a duty that
is perhaps more important in today's threat environment.
An example of our work in communicating crisis information
is as recent as last month. August brought Minnesota two
federally declared disasters, one natural and one manmade. The
intergovernmental response to the sudden collapse of the eight
lane I-35 W bridge in Minneapolis showed the Nation the
excellent level of preparedness that exists within our State.
Although 13 lives were lost, over 108 people survived the over
60 foot fall to the river due to the heroic efforts of all
levels of government personnel.
Another disaster struck Minnesota 17 days later as up to 20
inches of rain fell across seven counties in Southeast
Minnesota causing massive flooding resulting in seven
fatalities and $67 million in damage.
During both of these events, our FEB acted swiftly, passing
critical information from local and State government sources to
all Federal agencies on the recovery operations, road detours,
and other potential workforce impacts.
The response to these disasters by all levels of government
in the State was exemplary and was due to one vital element:
Trust through previous friendships. No business cards were
exchanged during any of these disasters among the responders.
FEB Minnesota has worked hard over the past 10 years, serving
as a catalyst in the Federal sector, to establish and maintain
these relationships with State and local government who are our
first responders.
We have helped many of our State and local partners through
our educational activities. Since 2001 our Federal Executive
Board has sponsored five tabletop exercises that are open to
all levels of government. In the past year we held two of
these. Pan Flu II, that had close assistance from the Minnesota
Department of Health and the Minnesota Division of Homeland
Security and Emergency Management.
The most recent that we held was Going to Red, that
explored the national threat of nuclear terrorism, culminating
with a 10 kiloton improvised nuclear device detonated outside
the capital city of Saint Paul.
During the past 6 years, we presented 20 half or full day
seminars with expert speakers on the hot topics of the day. And
since 2005 we have worked very extensively with officials at
the State Department of Health on a program to cover Federal
workers, critical Federal workers in the event of a pandemic or
a bioterrorism release so that they could continue their
crucial duties without interruption.
Three elements come together to make our FEB strong and
effective. The first is an active executive committee,
comprised of 33 senior Federal officials. The second is a great
intern program with over a dozen colleges and universities. And
the final part of the equation in making our FEB strong and
effective as financial and administrative support by a key
Federal agency, the Department of the Interior, through the
National Business Center in the Office of the Secretary.
In summary, including FEB roles and documents, in documents
like the National Response Framework will minimize the
duplication of Federal resources, especially in the areas of
crisis communications and training programs within Federal
field areas. Defining FEBs' existing functions in these
planning documents would foster a clear understanding of our
roles by the State and local governments that we partner with
on our training programs and preparedness activities. Thank you
again, Mr. Chairman, and I look forward to your questions.
Senator Akaka. Thank you very much, Mr. Morris. Ms.
Ainsworth, please proceed with your statement.

TESTIMONY OF KIMBERLY AINSWORTH,\1\ EXECUTIVE DIRECTOR, GREATER
BOSTON FEDERAL EXECUTIVE BOARD

Ms. Ainsworth. Good morning, Mr. Chairman, and thank you
for this opportunity to appear before you today to discuss the
role of Federal Executive Boards in pandemic preparedness. My
name is Kimberly Ainsworth and I am an employee of the EPA New
England Region and have been assigned to a long-term detail as
Executive Director of the Greater Boston Federal Executive
Board. I am here today in that capacity.
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\1\ The prepared statement of Ms. Ainsworth with attachments
appears in the Appendix on page 109.
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In this role I have primary responsibility for the
coordination and implementation of our programs and activities
under our lines of business. Federal Executive Boards have
played a meaningful role in emergency planning and response in
many ways since created in 1961. The U.S. Government is the
Nation's largest employer and among the top five in many areas
across our country, including Massachusetts. During emergencies
it is our responsibility to act uniformly to ensure the safety
of our employees and customers.
To that end, Federal Executive Boards play a vital role
from a workforce planning perspective. Although we are not
first responders, emergency managers, or law enforcement
professionals we can and do play an important role in public
safety. Federal Executive Boards are positioned to provide
crucial communication links among Federal agencies and State
and local officials alike.
More than 180 Federal agencies maintain a presence in
Massachusetts and approximately 90,000 citizens in our State
are employed civilian, military, and postal positions. Although
each Federal agency is responsible for the safety of its
employees and the continuity of operations, collaboration is
extremely important.
Our experiences in Boston prior to 2001 focused primarily
on weather-related events. However, in the post-September 11
environment local agencies have greater needs and expectations
of us. In 2002, Boston unveiled a comprehensive emergency
decision and notification plan outlining an all hazards
approach to emergency preparedness, response, and recovery from
a workforce perspective including during a pandemic.
We collected 24/7 contact information for our local agency
decisionmakers. A variety of communication strategies were
implemented and designed to ensure that we could disseminate
accurate, up-to-date, and consistent information around the
clock.
Our experiences have taught us that there is a significant
role that we serve during what I call perceived emergencies.
For example, the first national political convention, since the
2001 terrorist attacks, took place in Boston in 2004 and was
designated as a National Special Security Event. The Federal
Executive Board represented the Federal workforce during the
year-long security planning and also during the event itself.
Although it experienced no disruptions, there were several
instances where rumor threatened public safety. The Federal
Executive Board stepped in several times to coordinate the
collection and dissemination of real-time information from
subject matter experts within our Federal law enforcement
community. We were able to quickly provide local agency leaders
with accurate, consistent, and up-to-date information to make
informed decisions to ensure the safety of the Federal
workplace.
We employed similar procedures when, on July 7, 2005,
Americans awoke to reports of terrorist attacks on London's
public transportation system. At 9:38 a.m. in Boston on that
same day two subway trains were involved in a minor collision
underground. Although officials quickly determined that there
was no link to the London incidents, an intense flow of
misinformation circulated rapidly and the Federal Executive
Board was called in to action.
There are so many examples nationwide. From massive crowds
descending on government sites for civic rallies to extreme
weather events, Federal Executive Boards have consistently been
there to meet the information needs of our member agencies.
Most recently on January 31, 2007, Boston made national
headlines when a marketing scheme went wrong. Thirty-eight
electronic devices resembling Lite-Brite toys were placed in
public locations to promote a movie. The suspicious devices
sent public safety officials scrambling for many hours. Once
again, agency leaders called upon the Federal Executive Board
to provide accurate, up-to-date, and consistent information as
the situation unfolded.
I believe that this information sharing and communication
role will be increasingly important during a pandemic,
particularly given the likelihood of its extended timeframe and
anticipated widespread national impact.
Federal Executive Boards continue to be effective in this
regard while overcoming recurring challenges. Many were
captured in the May 2007 GAO report and are currently being
addressed. The first step was the development of a business
plan which includes two lines of business. These have, in
short, helped Federal Executive Boards gain the attention of
policymakers and increased credibility in our communities.
Thank you, Mr. Chairman, for this opportunity and I look
forward to your questions.
Senator Akaka. Thank you. Thank you very much, Ms.
Ainsworth. Mr. Goin, please proceed with your statement.

TESTIMONY OF MICHAEL GOIN,\1\ EXECUTIVE DIRECTOR, CLEVELAND
FEDERAL EXECUTIVE BOARD

Mr. Goin. Good morning, Chairman. And thank you for the
opportunity to appear before you today to discuss the role of
Federal Executive Boards in pandemic preparedness.
---------------------------------------------------------------------------
\1\ The prepared statement of Mr. Goin with attachments appears in
the Appendix on page 142.
---------------------------------------------------------------------------
Again, my name is Michael Goin and I am an employee of
NASA. Currently, I serve as the Executive Director of the
Cleveland Federal Executive Board, a position I have held since
2004.
Like my counterparts, I see my responsibilities as that of
ensuring the organization and delivery of programs and projects
to support the two distinct lines of business, all while
promoting communications, cooperation, and collaborations
across agency lines.
FEBs have attributed to the emergency response capability
of the Federal community, as many reports have stated. My
comments today will focus on the Cleveland FEB and what it has
done in the areas of emergency preparedness. It is my belief
that we serve a unique and vital coordinating role for our
community.
Our organization covers 94 agencies in more than 17
counties. However, I should admit that we also include into
that the Northern half of Ohio, where many of our agencies have
responsibility. The activities, projects, and programs of the
Cleveland FEB are coordinated utilizing special committees that
focus on activities, one of those being emergency preparedness.
As stated, FEBs are not first responders. However, we feel
that we enhance the response capability through our lines of
business, enhancing the readiness of our responders as well as
our employees.
Following September 11, 2001, we developed an all hazards
plan and an emergency contingencies procedures and guidelines
handbook to assist employees prior to, during, and immediately
following emergencies or a disruptive event to include a
pandemic. Through the efforts of the 28 FEBs, we are delivering
and adopting best practices and setting measurable goals and
adding credibility to the FEB as a source for emergency
preparedness and human capital needs.
Much has been accomplished, but I must say that more needs
to be done to ensure uniformity across the FEB network. Our FEB
has been very active in supporting our lines of business, as
well as developing partnerships with our State and local
agencies. We partnered with the Cuyahoga County Board of Health
to conduct a series of pandemic briefings designed to educate
employees and managers on the plans and procedures that will
help mitigate the effects of a pandemic outbreak.
We assisted FEMA with the distribution of emergency
preparedness cards for all civilian and contract employees in
our areas. We also enhanced our 24/7 notification system. Our
member agencies are now part of a national emergency
notification system, more commonly referred to as USP3. The
web-based system can issue notifications in multiple formats:
E-mail, text, text to voice, over 5,000 e-mail and text
messages, and up to 10,000 outbound calls in a matter of
minutes. Prior to that, sir, I would say that we were using a
calling tree that was very inefficient.
In response to the recent floodings that many Ohio counties
experienced, we will be adding a National Weather Service alert
to that warning system. In addition to the notification
capability, the system also provides members with a daily
global snapshot of world events. Many of those snapshots
include information relevant to pandemic concerns.
In a recent survey of our member agencies regarding their
challenges associated with the pandemic planning, many
identified issues related to telework programs. They are
seeking our assistance in clarifying telework, emergency
policies, hiring, and leave flexibilities. Much of that will be
accomplished with the help and assistance of the Office of
Personnel Management.
Many agencies point to the need for periodic security and
emergency preparedness training, credible information on new
developments, timely updates from reliable sources. I believe
our close working relationship with FEMA will help us in the
training needs. However, resource limitations may impact our
ability to deliver all that is needed and all that is expected.
As the GAO report stated, there are inconsistencies across
the FEB network in regards to different staffing levels,
different funding models, different resources and different
reporting structures. However, each Federal Executive Board
faces the same degree of responsibility and the same degree of
complexity in carrying out their duties. If FEBs are to be
effective in these areas, our positions will need to be
properly designated as having an emergency role? It should be
written down.
It is also my hope that the final version of the National
Response Framework will appropriately identify FEBs as having
that emergency and supporting role.
In closing, I would like to share with you a comment, made
by one of our agencies. It states: ``The FEB is the only venue
for agencies to interact with each other, thereby offering a
means of communication that would otherwise not exist.''
Thank you, Mr. Chairman, and I stand ready for your
questions.
Senator Akaka. Thank you. Thank you very much to the
panelists for your statement and your testimony.
I have a question for all of you. This hearing is to
discuss whether or not FEBs should have a formal responsibility
in emergency response planning and implementation. You have
heard from our first panelists. Do you agree with GAO's
recommendations? Mr. Morris.
Mr. Morris. I absolutely agree. I think that will make our
efforts and our job a lot easier, especially when we network
with our State and local counterparts, and also some of the
other Federal agencies because they will know that we really do
have an official seat at the table.
Senator Akaka. Ms. Ainsworth.
Ms. Ainsworth. I, too, agree and I agree with what the
previous panel said. I think that having it formally in writing
somewhere provides us with the credibility hat we need. Right
now there is lots of transition at the highest levels of
government. The regional directors and the heads of the
agencies transition sometimes every 2 years. The FEB is not yet
necessarily part of the transition package. So I think if we
have something in writing it provides us with the credibility
that we need.
Senator Akaka. Mr. Goin.
Mr. Goin. I would also agree with the panelists regarding
that and also remind you of the statement that we do believe
that we are the only entity that is capable of performing that
in our field. And our agencies have stepped forward and stated
they will be engaged and they will support the mission of the
FEB. So I think that is the right thing to do.
Senator Akaka. Mr. Morris, your FEB has led the way in
coordinating pandemic training programs and exercises. I would
like to commend you for your efforts.
Mr. Morris. Thank you, Mr. Chairman.
Senator Akaka. Aside from the issue of funding, what has
been the greatest challenge in integrating the FEB in the
emergency response planning?
Mr. Morris. The greatest challenge is really being able to
formulate those relationships, especially those critical
relationships with State and local government. Because for
field Federal agencies, we are really dependent upon them
because they are our first responders in any major disaster,
whether it be a biological disaster with a pandemic or a
weather-related--which Minnesota is rather famous for--or also
a terrorist related event.
Obviously, if we had some additional resources, additional
staffing even, that would be a greater help. But in light of
that, having the authority of being in the Federal response
plan would be a big help.
Senator Akaka. Thank you.
This one is for the panel. Funding for FEBs has been a
large topic of the conversation today. How do you generate
revenues and establish an operating budget, if you have one?
Let me ask Ms. Ainsworth first.
Ms. Ainsworth. In short, we are very entrepreneurial at the
Federal Executive Boards. In Boston, I am blessed to have a
wonderful network of agencies who are really there to support
me. So I know that I can ask for any level of resource, whether
it be a case of copy paper, something as simple as that, or
whether it be a person to help me with a particular event, a
body. I have agencies that are willing to contribute.
That said, I feel like it is a hat in hand approach where I
am continually going back to the trough and asking for these
things and some of that might dry up sooner or later. So a more
consistent funding stream would be beneficial to me and to
others.
Senator Akaka. Mr. Goin, how do you generate revenue?
Mr. Goin. Very much in the same manner. It is very
dependent upon our agencies in the collaboration and the
efforts as agencies step forward as we identify the needs. We
will tell them what the program is, what the program requires,
and then ask their assistance in delivering that.
But I should also state that I am very fortunate to be an
employee of NASA in our area, who have been very diligent about
ensuring that we have all of the resources that we need and
that are necessary for carrying our mission forward.
Senator Akaka. Mr. Morris.
Mr. Morris. I am one of the fortunate ones. I happen to be
a Washington employee of the Department of the Interior in the
Office of the Secretary. They fund two positions in Minnesota
very adequately and a modest budget for our office expenses and
regular needs.
However, we have some great local support, too, especially
from the Transportation Security Administration. They do a lot
of heavy lifting for us when we need some--the National Weather
Service and a number of different agencies--and really, the
whole Federal community at large will support us if we ask.
But again, our base funding is a fairly stable thing. And I
am the exception, rather than the rule.
Senator Akaka. Since you have experience in this system,
let me ask the panel again, outside of the direct appropriated
funds is there a logical funding source that could support your
efforts? Mr. Morris.
Mr. Morris. I think some of the issues that OPM is working
on in developing a national funding strategy at the chief human
capital officers level really deserves a lot of merit and
really would enable many Federal Executive Boards to really do
a lot more than be concerned about whether or not they are
going to have operating funds for the next 6 months.
One of the great assets that we have is that stable
funding. It is one of the primary reasons why we are able to
perform to such an extent in emergency management because we
have that base covered.
But I think what OPM has been doing in working with the
chief human capital officers, in getting really a consistent
funding scheme for the whole network, is a solution, an
important solution.
Senator Akaka. Mr. Goin.
Mr. Goin. I think that OPM's approach is appropriate and I
do believe that the answer is a national model and that way it
takes a lot of pressure off of the local to step forward in
that matter. We should be established in a manner where we have
uniformity across the entire FEB network. Everyone should be
operating from the same perspective, knowing what resources are
available at the beginning of each fiscal year and not trying
to establish it along the way.
So I think the answer is a national model and OPM is on the
right track and we will certainly--as FEBs in the field--assist
them in helping them understand what the local contribution
would be from that.
Senator Akaka. Ms. Ainsworth.
Ms. Ainsworth. I agree with what both of my colleagues have
said. Over many years I looked at many of the funding models
and considered how FEBs could operate. I often liken a strategy
to something like what GSA does with joint use space. A lot of
us are in GSA buildings and our office space is joint-use space
and GSA builds it into their rent schemes.
A similar funding agreement to something like the Federal
Protective Service has on the national level, where all
agencies contribute because the Federal Protective Service is
an agency that impacts everybody.
So I believe that OPM is on the right track in pursuing the
national model that they are looking at now.
Senator Akaka. Thank you.
Ms. Ainsworth, you mentioned in your testimony that earlier
this year the marketing scheme for a cartoon show created havoc
in the Boston area and agencies looked to the FEB to collect
and disseminate information. Being able to communicate is, of
course, essential in the event of an emergency.
What communications exercising have you done to be sure
that you will be able to communicate with the necessary people
in the event of an emergency?
Ms. Ainsworth. Mr. Chairman, it changes every day with
technology. In that particular case, it happened to be during
the day, in the daylight hours. So we were able to utilize our
e-mail schemes and get people when they were at their desks and
they have blackberries and whatnot. So we, in that particular
case, did focus primarily on electronic communications.
We do have now, we are part of the USP3 network, where we
will be able to use telecommunication systems which will be a
voice message and also text messaging to complement the e-mail.
So there will be three ways that we can communicate 24 hours a
day with our members.
Senator Akaka. If you were to look at highlights, what
strengths and weaknesses have these exercises highlighted?
Ms. Ainsworth. I think our strengths are our ability to
quickly get information and, as you heard me say several times,
accurate, consistent, and up to date information out there. I
talked a little bit about our experiences with perceived
emergencies. And a lot of perceived emergencies are generated
due to blogs and people getting online and talking about things
or media picking up on a story and just sensationalizing a lot
of it.
So our ability to be able to, for lack of a better word,
fact check some of the information that is surfacing in these
forums has really provided us with credibility.
We find that we are a greater resource to the non-law-
enforcement and military agencies, the agencies that I call the
administrative types, Social Security, IRS. We all work in the
same buildings and rumor spreads very quickly, particularly
when folks are on the Internet or watching television during
the day.
Senator Akaka. Mr. Morris, next year the Republican
National Committee will hold its national convention in the
Twin Cities. This could create a range of challenges in the
event of a pandemic outbreak or other emergency. What role are
you playing in preparing for this large national event? Are you
working with the Boston and New York FEBs, which hosted
national party conventions in the year 2004? What are you doing
here?
Mr. Morris. Last winter we asked for both Boston and New
York's after action reports from both the DNC and the RNC
conventions in their respective cities. And then, in the early
spring we had the U.S. Secret Service Special Agent in Charge
come into our executive committee and give a briefing for all
of us on all of the aspects on the National Special Security
Event.
For this fiscal year we also had him come on our executive
committee. We have also been working with both local and State
government. Again, in Minnesota, we really know everybody on a
first name basis, all of the major players in law enforcement
and emergency management. And we are anticipating in the spring
and probably early summer putting on a major, probably a
daylong seminar on the ramifications of the Republican National
Convention from September 1-4, 2008.
Senator Akaka. Ms. Ainsworth, GAO recommends that
performance standards be established for FEBs. Would this be a
helpful tool or a hindrance to your preparedness work?
Ms. Ainsworth. I personally applaud it. I think it is a
great mechanism and I think they should exist. I think it will
help us a lot.
Senator Akaka. Mr. Goin.
Mr. Goin. I believe it will give us a clear direction and
something to work towards throughout the year. We can set our
strategic position to go in that direction to ensure we are
meeting those.
Senator Akaka. Mr. Morris.
Mr. Morris. I agree with my colleagues on that point.
Senator Akaka. I want to thank all of our witnesses for
your thoughtful testimony and answers to the questions. There
is clearly a lot more that needs to be done to prepare for a
pandemic outbreak, and including FEBs in that planning.
In addition, we need to look beyond the Federal emergency
response professionals and look to the preparation of the
larger Federal employee population.
Senator Voinovich and I have asked the Government
Accountability Office to examine how well prepared the Federal
workforce is in the event of a pandemic influenza outbreak and
I am sure we will hold a hearing when that report is released.
And so we look forward to continuing to hear from you and to
improve the system so that we can deal and respond whenever it
is necessary.
With that, again, I want to thank all of you for being
here.
This hearing is adjourned.
[Whereupon, 11:23 a.m., the Subcommittee was adjourned.]

PREPARING THE NATIONAL CAPITAL REGION FOR A PANDEMIC

----------

TUESDAY, OCTOBER 2, 2007

U.S. Senate,
Subcommittee on Oversight of Government
Management, the Federal Workforce
and the District of Columbia,
of the Committee on Homeland Security
and Governmental Affairs,
Washington, DC.
The Subcommittee met, pursuant to notice, at 10:03 a.m., in
Room SD-342, Dirksen Senate Office Building, Hon. Daniel K.
Akaka, Chairman of the Subcommittee, presiding.
Present: Senator Akaka.

OPENING STATEMENT OF CHAIRMAN AKAKA

Senator Akaka. This hearing will come to order. Good
morning and welcome to our panel and to all of you in this
room.
I would like to thank all of you for joining us at this
hearing to discuss the status of pandemic preparedness in the
National Capital Region (NCR). This is the second in a series
of three hearings that our Subcommittee is holding related to
pandemic influenza. Last week, we heard about the role of the
Federal Executive Boards in responding to an outbreak, and on
Thursday afternoon, we will discuss global surveillance of
emerging infectious disease.
Public health experts believe that the world is overdue for
a pandemic influenza outbreak. The Spanish flu pandemic of 1918
and 1919 killed approximately 40 million people around the
world. Beyond this tremendous death rate, an estimated 20 to 40
percent of the population fell ill. The Centers for Disease
Control and Prevention estimate that a flu pandemic could kill
between 2 to 7.4 million people worldwide. In the United
States, an estimated 200,000 people could die and another 2
million people could become ill. In short, we must prepare our
communities to protect lives.
The effect of pandemic in our Nation's Capital, the heart
of the Federal Government, would be dramatic. Comprised of 11
local jurisdictions, the District of Columbia, and parts of
Maryland and Virginia, the NCR is home to over 5 million
people, 340,000 Federal employees, 40 colleges and
universities, and 27 hospitals. The NCR has the second-largest
rail system in the country and hosts nearly 20 million tourists
each year.
To help coordinate planning and response with the State,
local, and regional authorities in the NCR, Congress
established the Office of National Capital Region Coordination
in the Homeland Security Act of 2002. In the past 5 years, we
have spent millions of dollars through DHS and HHS grants to
prepare the NCR for natural disasters, public health
emergencies, pandemics, and potential terrorist attack.
According to the World Health Organization, since 1997, 328
people from South East Asia to Africa and Europe have been
killed as a result of the bird flu or the H5N1 virus strain. In
response to the growing threat, the CDC and HHS have granted
Maryland, Virginia, and the District of Columbia a total of
nearly $90 million in fiscal years 2006 and 2007 for pandemic
preparedness. Congress has appropriated more than $7.5 billion
since 2004 for pandemic flu-related activities, including $6.1
billion to HHS in fiscal year 2006 to work with the States on
stockpiling antiviral drugs and vaccines.
In 2005, the CDC required all States to develop strategic
plans for pandemic influenza, and in 2006, the CDC required the
States to exercise them. In May 2006, the White House released
a National Strategy for Pandemic Influenza. In addition, the
local jurisdictions and NCR have their own strategic plans for
pandemic influenza. However, while the NCR as a whole has a
strategic plan for security in the event of a terrorist attack
or a disaster, there is no regional strategic plan specifically
for pandemic influenza. I think this will be a useful tool to
develop, and so this hearing is part of planning for that.
Strategic plans are just the first step. These plans must
be tested through repeated training and exercising. Weaknesses
can be found and improvements can be made. This is the only way
that the National Capital Region can become adequately prepared
to face the pressing issue of a pandemic influenza outbreak. I
am pleased to hear that DC will host an exercise with
nonprofits on pandemic preparedness later this month.
Like the NCR, my home State of Hawaii faces unique
challenges in pandemic flu preparation with its large tourist
population and location between Asia and the contiguous States.
The Hawaii Department of Health has been working hard to
address pandemic preparedness, and earlier this year Hawaii
held a massive exercise simulating a plane crash of a flight
from Indonesia heading to Mexico City. The exercise scenario
included passengers infected with avian influenza. It required
Federal, State, local, and military responders to treat
injuries related to the crash and possible exposure to avian
flu. Participants walked away from the exercise understanding
the importance of interoperable communication and the need for
medical surge capacity.
In our Subcommittee hearings last year, we discussed the
importance of interoperable communication in the NCR and the
challenges to achieve interoperability with so many
jurisdictions in the region. I believe you all have made great
strides in this area and I want to congratulate you on these
efforts, but there are other problems that need to be
addressed.
Pandemic flu will be a shock to the entire medical system.
Most hospitals function at capacity and leave little room for
surge. Twenty-five percent of the population could be infected
by the pandemic strain over a period of months or even years.
Patients' needs could far outstrip available hospital beds,
health professionals, and ventilators, and I understand that
DC, Maryland, and Virginia have made improvements for medical
surge capacity, but more needs to be done to look at alternate
sites for care and altered standards of care during a pandemic
emergency.
Medical surge capacity is only one of the challenges
related to treatment and public health response. Keeping our
government's services running and caring for other sick
patients are also distinct challenges in the event of a
pandemic disease outbreak. I know that you all have put a lot
of thought and energy into developing plans and working
together to prepare for a pandemic. I am interested in hearing
about the good work that I know is being done by the various
jurisdictions in the region, how HHS and DHS are helping in
that process, and areas where efforts can be improved.
I want to welcome our panel this morning and introduce Dr.
Kevin Yeskey, Director of the Office of Preparedness and
Emergency Operations and the Deputy Assistant Secretary in the
Office of Preparedness and Response at the Department of Health
and Human Services.
We have Christopher Geldart, Director of the Office of
National Capital Region Coordination at the Department of
Homeland Security.
We have Robert Mauskapf, Director of Emergency Operations,
Logistics, and Planning in Emergency Preparedness and Response
for the Virginia Department of Health.
And we have Darrell Darnell, Director of the Homeland
Security and Emergency Management Agency for the District of
Columbia and a Member of the Senior Policy Group in the
National Capital Region.
I would like to note at this time that we also invited a
representative from the State of Maryland to participate in the
panel discussion this morning, but they were unable to provide
a witness. I do, however, look forward to viewing their
testimony to find out what their efforts have been on behalf of
preparing the National Capital Region for pandemic influenza.
Our Subcommittee rules require that all witnesses testify
under oath. Therefore, I ask all of our witnesses to please
stand and raise your right hand.
Do you solemnly swear that the testimony you are about to
give to this Subcommittee will be the truth, the whole truth,
and nothing but the truth, so help you, God?
Dr. Yeskey. I do.
Mr. Geldart. I do.
Mr. Mauskapf. I do.
Mr. Darnell. I do.
Senator Akaka. Thank you. Let it be noted for the record
that the witnesses answered in the affirmative
All witnesses will have 5 minutes to summarize their
testimony, and without objection, your full written statements
will be included in the record.
So we will begin with Dr. Yeskey. Dr. Yeskey, will you
please proceed with your statement?

TESTIMONY OF KEVIN YESKEY, M.D.,\1\ DEPUTY ASSISTANT SECRETARY,
AND DIRECTOR, OFFICE OF PREPAREDNESS AND EMERGENCY OPERATIONS,
OFFICE OF THE ASSISTANT SECRETARY FOR PREPAREDNESS AND
RESPONSE, U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Dr. Yeskey. Good morning, Chairman Akaka. Thank you for the
opportunity to present the progress HHS has made in
preparedness for pandemic influenza in the National Capital
Region.
---------------------------------------------------------------------------
\1\ The prepared statement of Dr. Yeskey appears in the Appendix on
page 150.
---------------------------------------------------------------------------
The ASPR mission is to lead the Nation in preventing,
preparing for, and responding to the adverse health effects of
public health emergencies and disasters and the vision we have
is a Nation prepared. Like our response counterparts in other
agencies, ASPR has taken an all-hazards approach to public
health preparedness planning. The gains we make in increased
preparedness and response capability for pandemic influenza
will help us in preparing for other emergencies and disasters.
My oral testimony will focus on the Federal preparations
for the National Capital Region and how HHS is supporting
Maryland, Virginia, and the District of Columbia in their
pandemic influenza preparations.
In November 2005, the President released the National
Strategy for Pandemic Influenza, followed by a detailed
implementation plan from the Homeland Security Council in May
2006. HHS also released its pandemic implementation plan and
developed an operational plan, or as we call it, the ``Pandemic
Influenza Playbook,'' which details how HHS will coordinate the
deployment and utilization of Federal medical resources. Our
goal for the next year is to work with States to develop
regional playbooks that will continue to promote integrated
planning across tiers of government.
HHS also published multiple documents to assist State and
local public health officials in their preparations for
pandemic influenza. Two documents of note are the ``Interim
Pre-Pandemic Planning Guidance: Community Strategy for Pandemic
Influenza Mitigation in the United States.'' This publication
provides detailed strategies for the use of non-pharmaceutical
interventions, such as social distancing.
The second publication, called the ``Community Planning
Guide on Mass Medical Care with Scarce Resources,'' provides
guidance to health care professionals, permitting them to
provide the highest possible standards of care in situations
where resources are scarce. Included in this guide is a
pandemic influenza case study.
HHS recognizes the lead role of the Department of Homeland
Security during disasters of national scale. We support DHS by
providing public health and medical expertise in all disasters
and will do so in a pandemic. With regard to pandemic
influenza, HHS has identified six senior health officials to
support the DHS pre-designated pandemic principal Federal
officials. Our six senior health officials have been working
hand-in-hand with the DHS PFOs at the regional, State, and
local levels and have participated in exercises, roundtable
discussions, and other preparedness activities.
HHS has provided preparedness funding to States and local
governments through two mechanisms, cooperative agreements and
emergency supplemental funding. HHS has two cooperative
agreements that aid in all-hazards preparedness, including
pandemic influenza. The Hospital Preparedness Program is
managed by ASPR and provides funds to States for surge
capacity, development of alternative care facilities for health
care during disasters, regional coordination among hospitals,
and exercises. The Public Health Emergency Preparedness
Cooperative Agreement managed by CDC funds public health
activities such as surveillance, lab support, and exercises.
This year, $25 million was made available for a competitive
award program that addressed surge capacity in hospital
emergency care. Five health care facilities were awarded $5
million each under this program and one of the awardees was the
Washington Hospital Center here in the District of Columbia.
Emergency supplemental funding has been designated
specifically for pandemic influenza. By the end of this year,
the Department will have awarded over $600 million in emergency
supplemental funding through the CDC and ASPR to States, the
District of Columbia, and other jurisdictions to upgrade State
and local capacity with regards to pandemic preparedness.
The funding has occurred in three general phases. Phase one
was used to assess gaps in pandemic planning and guide
preparedness investments. Additionally, each State conducted
summits between senior HHS officials and State officials and
these summits were intended to facilitate community-wide
planning and to promote shared responsibility for pandemic
preparedness.
Phase two funds were used to develop an operational work
plan to address identified gaps from phase one and to develop
an antiviral drug distribution plan. Awardees also developed a
pandemic exercise schedule.
Phase three funds will be used to address any outstanding
gaps identified in phases one and two, such as stockpiling of
ventilators, personal protective equipment, alternate care
sites, mass fatality planning, and medical surge exercises, and
these will be awarded as supplements to jurisdictions that
currently receive awards through HHS cooperative agreements.
Also in 2007, ASPR placed a Regional Emergency Coordinator
within the DHS Office of National Capital Regional Coordination
to enhance the HHS contribution to this very important office.
It is our objective to provide a full-time resource to the
director of this office who can provide public health
expertise, enhanced coordination and preparedness planning, and
improved communications between the director and HHS.
The responsibility for pandemic preparedness is shared at
the local, State, and Federal levels and includes private as
well as public partners. HHS has provided funding and guidance
to our State partners and we have actively engaged in workshops
and exercises with our State and local partners to advance
pandemic preparations. In the NCR, we have enhanced our
partnership with the Office of National Capital Region
Coordination by providing a full-time Emergency Coordinator to
assist with public health and medical preparedness.
Thank you for the opportunity to present progress HHS has
made in preparedness for pandemic influenza. With your
leadership and support, we have made substantial progress. The
threat remains real. We have much left to do to ensure that we
meet our mission of a Nation prepared for a potential influenza
pandemic.
This concludes my testimony and I will be happy to answer
any questions. Thank you.
Senator Akaka. Thank you very much, Dr. Yeskey. Now we will
hear from Mr. Geldart.

TESTIMONY OF CHRISTOPHER T. GELDART, DIRECTOR, OFFICE OF
NATIONAL CAPITAL REGION COORDINATION, U.S. DEPARTMENT OF
HOMELAND SECURITY

Mr. Geldart. Thank you, sir. Good morning, Chairman Akaka.
Senator Akaka. Good morning.
Mr. Geldart. Thank you for the opportunity to appear before
the Subcommittee today to discuss the role of the Office of
National Capital Region Coordination within the Department of
Homeland Security's Federal Emergency Management Agency.
I will describe how we work with our Homeland Security
partners to enhance preparedness within the National Capital
Region, and more specifically, our role in ongoing pandemic
influenza initiatives as part of our core mission in the
region.
The Chairman gave a very accurate summary of the National
Capital Region, of what is at stake here in this region and
also of the office that was created to help address that from
the Federal perspective. The major role of the office is to
oversee and coordinate Federal programs for and relationships
with State, local, and regional authorities. The office
originally was within the Office of the Secretary at DHS.
However, with the passage of the Post-Katrina Emergency
Management Reform Act of 2006, the Office of National Capital
Region Coordination became a component of FEMA. We directly
report to the FEMA Administrator.
The office coordinates daily with local, State, regional,
Federal, private sector, and nonprofit entities. Some of those
entities include the Joint Federal Committee, the Metropolitan
Washington Council of Governments, Regional Emergency
Preparedness Council, the National Capital Region Senior Policy
Group, and FEMA Region III.
Since joining the office 5 months ago and looking at the
overarching priorities of the office, three major areas came to
the top. The first one is to enhance regionally coordinated
catastrophic planning. We helped to initiate and we participate
on the NCR Evacuation and Sheltering Plan Working Group led by
the District of Columbia's Homeland Security Emergency
Management Agency. We work with our partners at all levels of
government in the region to coordinate activities of this
Working Group with Federal continuity programs. There is an
opportunity to take a substantial leap in the NCR in
catastrophic planning as we are now in the Federal Emergency
Management Agency, and looking at that agency's vision as it
moves forward.
Our second area that we looked at is enhanced Federal
coordination in the NCR. The National Capital Region
Coordination Office is working on strengthening the Federal
coordination with our State and local partners. We do this
through our Joint Federal Committee. We do this through the
several regional emergency support functions, which I am sure
my colleague, Darrell Darnell, will address when he gives his
testimony. Operationally, the NCRC in its standing Federal
coordination role ensures the coordination of Federal
protective measures in advance of and immediately following an
event.
The last area that we focus on is the Comprehensive
Regional Risk Assessments. The region is committed to doing
Regional Risk Assessments to focus its limited resources on the
top key issues for the area. We have conducted several and we
are refining the process. Within these priorities, pandemic flu
is a major consideration. To meet the challenge of pandemic
influenza, there are many entities that have a role in
preparedness in the National Capital Region.
The Department of Homeland Security's role as described in
the implementation plan for the National Strategy for Pandemic
Influenza is to coordinate the overall Federal response during
an influenza pandemic. The Federal Emergency Management
Agency's role during a pandemic influenza outbreak is to
coordinate the identification, mobilization, and deployment of
Federal resources to support the life-saving and life-
sustaining needs of the States and their populations.
In March of this year, the Federal Emergency Management
Agency published a Disaster Assistance Policy establishing the
types of emergency protective measures eligible for
reimbursement to States and local governments during a Federal
response to a pandemic influenza, among other things.
The role of the National Capital Region Coordination Office
does not lead efforts to create pandemic influenza contingency
plans. However, we coordinate and synchronize Federal
interagency planning efforts with the National Capital Region
jurisdictions. Our coordination efforts ensure complementary
multi-jurisdictional planning for preparedness, response, and
recovery actions in the region.
A pandemic influenza differs from any other--most other
events that may happen in this region. It will last much
longer. It will come in waves. The numbers of health care
workers and first responders available can be expected to be
reduced. Resources in many locations will be limited, depending
on severity and spread of a pandemic influenza.
Given this, let me tell you how the National Capital Region
Coordination Office is working towards its three priorities
with its partners in addressing pandemic influenza.
The NCRC works in close coordination, as Dr. Yeskey has
just mentioned, now with an HHS person on board to coordinate
the activities and the grant streams that HHS has ongoing. We
also work with HHS and the Department of Homeland Security in
bringing a public health officer into our office, as well, to
help coordinate planning between State, Federal, regional, and
local authorities.
To enhance our Federal coordination within the region,
FEMA, the National Continuity Programs disseminated their
pandemic influenza guidance to more than 70 Federal departments
and agencies in the NCR. We have coordinated with the General
Service Administration to use the Federal Virtual Workplace in
the event of a pandemic influenza, and the U.S. Postal Service
regarding potential role in distributing prophylaxis. There are
several exercises that either recently have been conducted or
that are planned, and I will be glad to cover any of those that
the Chairman would want me to go over.
And the last is in our regional risk assessment area. Of
course, pandemic influenza is a major piece in that.
In conclusion, I would like to say that the NCRC is at an
exciting crossroads as it continues its central preparedness
and coordination missions as part of the Federal Emergency
Management Agency. Building upon the foundation that has
already been constructed, the NCRC will continue to take
proactive steps with our Homeland Security partners to protect,
prepare for, respond, and recover from the public health threat
posed by pandemic influenza.
Thank you, Chairman Akaka and Members of the Subcommittee,
for the opportunity to discuss the role of FEMA's Office of
National Capital Region Coordination. I will be glad to answer
any questions that you have, sir.
Senator Akaka. Thank you. Thank you very much, Mr. Geldart.
Now we will hear from Mr. Mauskapf. Please proceed with
your statement.

TESTIMONY OF ROBERT P. MAUSKAPF,\1\ DIRECTOR, EMERGENCY
OPERATIONS, LOGISTICS, AND PLANNING IN EMERGENCY PREPAREDNESS
AND RESPONSE PROGRAM, VIRGINIA DEPARTMENT OF HEALTH

Mr. Mauskapf. Thank you, Chairman Akaka, for this
opportunity to address the Subcommittee on this very important
issue. I am Bob Mauskapf from the Virginia Department of Health
and I want to discuss the activities in Virginia in combatting
the potential for a pandemic.
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\1\ The prepared statement of Mr. Mauskapf appears in the Appendix
on page 166.
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Three points that I would like to emphasize are that
Virginia has undertaken extensive planning efforts for a
possible pandemic. Additionally, the three jurisdictions within
the National Capital Region work closely together on all
aspects of emergency planning and response. And there needs to
be closer collaboration and communication on NCR emergency
planning between the three jurisdictions and the Federal
Government.
Monthly activity reports from throughout Virginia provide
the governor anecdotal descriptions of local, regional, and
State preparations. Pandemic influenza plans are coordinated
across the NCR at State and local levels. School systems,
private sector, critical infrastructure partners, all are
collaborators in this effort.
One important gap in our planning is the coordination with
key Federal agencies. NCR jurisdictions must be integrated into
Federal continuity of operations and continuity of government
planning. Federal employees live in our neighborhoods and are
dependent on our services. If there are any preferential
expectations to assist in the continuity of Federal operations,
they have not been shared with us.
Under continuity of operations, governor Kaine has issued
an Executive Order directing the State and all State agencies
to create and update continuity of operations plans. Among the
issues that are addressed in these plans are workforce
reduction, staffing support coordination, identification of key
personnel skills, leadership succession, systems readiness, and
prioritization of agency functions.
Communications efforts focus on pre-scripted public service
and public health announcements, keeping the media engaged,
developing public education opportunities and materials, and
developing message maps and establishing a public inquiry
center.
All treatment planning has been collaborative with the
health care community and specifically with the Commonwealth's
90 acute care hospitals. Mass vaccination plans have been
developed and exercised at both the State and local levels.
Virginia has focused much effort in the refinement of its
antiviral distribution plan. Governor Kaine has authorized the
purchase of over 770,000 courses of antivirals, now on hand
within the Commonwealth. It is hoped that the Federal Drug
Administration will approve shelf life extension programs for
the States, thereby protecting this significant investment and
extending the longevity of these medications.
In preparing for a possible pandemic event, the
Commonwealth will distribute to target populations through a
regional delivery network, to private sector pharmacies,
military TRICARE clinics, community health centers, dispensing
physicians, health care facilities, and local health
departments. The plan is designed to provide antivirals to
treat up to 25 percent of the State's population. This
percentage is based on worst-case modeling from the 1918
pandemic. Participating pharmacies will receive and dispense
the medications at no charge. A tracking system will assure
that each individual receives only one course.
On the medical surge, approximately 3,600 staff beds are
available State-wide for the influx of surge patients within 4
hours of notification. The immediate bed surge capacity within
this 4 hours for the Virginia portion of the NCR is 780 beds.
Surge capacity within 24 hours amounts to 5,600 patient surge
beds among normal staff beds within the Commonwealth.
Virginia continues to identify additional potential
alternate care sites to enhance the treatment of patients.
Additionally, the use of mobile medical assets is a valuable
option for providing medical stabilization and treatment
outside of hospitals. Stabilization and treatment-in-place
units are now in place for four of our six hospital regions. A
vendor-managed inventory surge plan now under consideration
proposes to provide medical surge materials from two locations
to all of our sites within Virginia.
In August 2006, Virginia hosted a State-wide pandemic
influenza tabletop exercise and followed it up in October of
that year with a full functional exercise. All 35 local health
districts participated and they operated 77 mass vaccination
clinics and vaccinated over 10,800 citizens with annual flu
vaccine provided by the State. Last month, Governor Kaine led a
cabinet-level pandemic flu tabletop exercise. State and
regional caches of antiviral treatment courses are in place to
provide treatment to over 37,000 hospital staff. That is
approximately 30 percent of the Commonwealth's hospital
employees.
In summary, Virginia has planned extensively for a possible
pandemic. Collaboration among Virginia, Maryland, and the
District is extensive and productive. Increased direct
involvement of Federal agencies in the planning process is
required.
Thank you for this opportunity to address the Subcommittee
and I will be glad to take your questions.
Senator Akaka. Thank you very much, Mr. Mauskapf.
Now, Mr. Darnell, will you please proceed with your
statement.

TESTIMONY OF DARRELL L. DARNELL,\1\ DIRECTOR, DISTRICT OF
COLUMBIA HOMELAND SECURITY AND EMERGENCY MANAGEMENT AGENCY

Mr. Darnell. Good morning and thank you, Chairman Akaka,
for the opportunity to appear today to discuss pandemic
preparedness in Washington, DC and the National Capital Region
(NCR).
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\1\ The prepared statement of Mr. Darnell appears in the Appendix
on page 176.
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A pandemic is likely to cause both widespread and sustained
effects and is thus likely to stress the resources of every
State nearly simultaneously. This anticipated resource drain
will make it difficult for States to assist each other, thereby
reinforcing the need to develop a plan that reflects a
substantial degree of self-reliance.
The District's response to a pandemic will include
significant governmental coordination, communication to the
public, increased medical surge capacity, and first responder
protection. The District's Pandemic Influenza Preparedness Plan
provides a framework to prepare for and respond to a pandemic.
The plan is based upon the pandemic phases determined by the
Centers for Disease Control and Prevention, in collaboration
with the World Health Organization. These phases help identify
the estimated impact of a pandemic on the government,
residents, and visitors. These defined phases help ensure a
consistent and coordinated response by the District of Columbia
Government in the event of a pandemic.
To facilitate homeland security collaboration at the
regional level, the NCR leadership established a Health and
Medical Regional Programmatic Working Group which addresses
mass vaccination and mass dispensing issues, as well as the
Surge Subcommittee which addresses mass fatality planning
throughout the NCR. These groups provide forums for regional
planning and cooperation related to pandemic preparation, and
to encourage local coordination, the District has developed
partnerships with the business community and the city's
hospitality industry in order to enhance preparation and
response efforts.
In addition to forming partnerships, we have worked to be
certain that before, during, and after an emergency, we are in
a position to provide timely, accurate, and easily understood
information and instructions to the public. The District has
made information about pandemic influenza planning and
preparedness widely available through websites as well as fact
sheets and preparedness checklists for the media, schools,
businesses, and public safety officials.
And to help ensure the efficacy of our planning and
training efforts, the District has conducted a number of
pandemic influenza-related exercises that have focused on
managing Strategic National Stockpile assets in response to a
pandemic flu outbreak in schools and the hospitality industry.
Further, on October 17, we will participate in an exercise with
nonprofit organizations to test their continuity of operations
plans using a pandemic flu scenario. These exercises have
familiarized District personnel and the public with pandemic
response plans and they have demonstrated the ability of DC
agencies to coordinate the response effectively.
But, of course, a crucial aspect of pandemic response is
early identification. District hospitals report diagnosed cases
of influenza on a daily basis, which are compiled and compared
against normal seasonal patterns. This monitoring will reveal
an unusual or sudden spike in flu-like symptoms being reported
at multiple hospitals and will notify public health officials
of it early on.
Turning to medical surge capacity, in the event of a
pandemic influenza outbreak, the number of patients seeking
treatment at hospitals in the region would soar. The District
and the NCR have invested in increasing hospital surge capacity
in previous years to expand hospitals' ability to accept a
larger than normal volume of payments. Throughout the NCR, the
number of additional surge beds that were created was 2,367,
and approximately one-third of those are located in hospitals
here in the District of Columbia.
In order to effectively treat the large number of affected
individuals who will need medical treatment during a flu
outbreak, it is critical that hospitals, public health, and
emergency medical service providers have adequate protection so
that they themselves do not become infected. The District of
Columbia and the NCR have purchased protective equipment for
health personnel in order to maintain their safety while
treating the public during a pandemic.
In conclusion, the District is continually preparing for
response to a pandemic through the following activities:
Identifying public and private sector partners needed for
effective planning and response; planning for key components of
pandemic influenza preparedness, including surveillance,
vaccine, and antiviral distribution and communications;
integrating pandemic influenza planning with other activities
conducted under the Centers for Disease Control and Protection
and the Health Resources Services Administration's Bioterrorism
Preparedness Cooperative Agreements with the States;
coordinating local plans and providing resources to assist in
the planning process; exercising our plans; and continually
coordinating with adjoining jurisdictions.
Thank you again for the opportunity to testify before you
today, and I welcome any questions you may have.
Senator Akaka. Thank you very much, Mr. Darnell.
Dr. Yeskey, according to CDC, among the three flu strains
it is preparing for in the 2007 and 2008 season, one of them is
a type AH3N2. This strain is linked to the 1968 Hong Kong
pandemic flu, the deadliest flu in the past 30 years, which
killed two million people worldwide. What is the outlook for
this upcoming flu season and are we prepared for this type of
influenza?
Dr. Yeskey. I would say that the preparedness activities
that we are undergoing for pandemic influenza put us in a
position to be able to respond better to any influenza,
seasonal influenza that we might see this year. I can't comment
specifically on the vaccines associated with that. I just don't
have that material available. I would be happy to provide that
answer to you. But I think because we have preparations in
place for pandemic influenza, we have done some exercises, we
have done planning, we have done a number of different
activities related to pandemic influenza, this puts us in a
better position to respond to seasonal influenza, as well.
Senator Akaka. You just mentioned that there has been an
improvement in preparedness. Can you mention something about
just one part of the preparedness that you have been working
on?
Dr. Yeskey. Sure. I think a number of things. One, with
regards to our exercises that we have done, a number of States
have used seasonal flu clinics as a model for pandemic
influenza mass vaccination, so we have looked at that, so that
is an area where State and local authorities have practiced
their seasonal influenza clinics and gaining efficiencies in
those areas. In fact, Admiral Vanderwagen, the Assistant
Secretary in our office participated in a drive-through
seasonal flu vaccination clinic in his home county in Maryland
last year.
We have exercised distribution plans for antivirals. We
have hospitals that have looked at surge capacity and how to
enhance their ability to respond to a peak in influenza
patients. So I think those are areas where we have seen
improvements in our preparedness for pandemic influenza that
should carry over into seasonal influenza.
Senator Akaka. Mr. Darnell, the first human-to-human
transfer of H5N1 Avian influenza occurred in Indonesia last
year and this is alarming. The first question everyone has in
mind is, if NCR were hit with a pandemic influenza this season,
are we ready?
Mr. Darnell. Well, Mr. Chairman, I think we have taken all
the steps that we possibly can to be ready. We have developed
plans. We have exercised those plans. We have coordinated those
plans with our partners within the NCR as well as with the
Federal Government. We have also reached out to the hospitality
industry, as well, because a major part of our economy is
tourism. A number of people come through this area, and if I
understand your question, the gist of it, it could spread
really rapidly.
In fact, we recently held an exercise this past September
10 with the hotel and hospital industry in the NCR about an
airborne disease that could affect people who were attending a
convention here and who then traveled up and down the Eastern
Seaboard. So we have stockpiled antivirals that we would need
here and we also have the surveillance tracking system, and
then working with the hospitality industry and their folks, as
well, on how we could track people who are here for
conventions, who are here visiting the Nation's Capital, and
then follow up with those people in the event that they were
infected or potentially could become infected.
Senator Akaka. Mr. Mauskapf.
Mr. Mauskapf. I believe we are ready. With the stockpiling
of over 770,000 courses of antivirals already on hand, the
enlisting of over 600 pharmacies to aid us in dispensing, the
development of a distribution network with private distributors
backed by UPS and our State resources, exercising both mass
vaccinations once vaccine becomes available every year for the
past 3 years, exercising points of dispensing at the drive-
through clinics and other asymmetric types of forms of
dispensing, with the governor's executive-level decisionmaking
exercise that he conducted with his entire cabinet earlier last
month, and with our participation regionally in the upcoming
National Governors Association Region 3 exercise, which will go
on November 8 and 9 here in the National Capital Region, I
believe that we have made great strides toward preparedness.
Senator Akaka. Thank you. Mr. Geldart, along the lines of
strategic planning for such an event, I know that it took all
the jurisdictions working together with ONCR a number of years
to develop the NCR security strategic plan. The regions have
individual strategic plans for pandemic influenza, but it seems
like a cohesive plan for the NCR would be a useful tool. Has
this come up in your meetings within the NCR and could you work
as a facilitator to develop such a plan?
Mr. Geldart. Mr. Chairman, I would say that we do have a
National Capital Region strategic plan. Within that strategic
plan, we have a focus area that covers many of the aspects, if
not all of the aspects, that go into mass care, medical surge,
mass prophylaxis areas, which are the key pieces that go into a
pandemic influenza plan.
To create a regional plan for pandemic influenza would
definitely be a discussion that myself, Mr. Darnell, and the
other folks that make up the Senior Policy Group in the
National Capital Region would have to discuss to ensure that
each State and entity that would take part in that would find
usefulness in creating a regional plan, or is there a way that
with the exercises that we do and the strategic plan that we
have for the region, do they believe--do we all believe that
covers us, how we need to for pandemic influenza planning. If
they were willing, sir, I would be willing to facilitate, yes,
sir.
Senator Akaka. Thank you. We look upon you and the
Department of Homeland Security to be a kind of facilitator to
bring these groups together.
Doctors and pharmacists across the country are already
offering flu shots. With the flu season upon us, there is a
real opportunity for the NCR to test strategic plans that you
all have been working on. What exercises are scheduled for NCR
to use this flu season to test current plans for a pandemic flu
outbreak? Mr. Mauskapf.
Mr. Mauskapf. Our mass vaccination with using annual flu
vaccine was so successful last year that we have purchased an
additional 12,000 doses of annual flu vaccine and have actually
taken delivery of pre-loaded syringes and needles, and we have
provided that to 19 of our 35 health districts, and they will
be conducting mass vaccination exercises during October and
November.
Some of the settings, for example, within the National
Capital Region, in Loudoun County, we will actually be in a
high school and do mass vaccinations during a class session,
one hour, and we will test and use performance metrics to
determine how long it takes to put each individual through the
line to receive a vaccination. We will repeat this in several
other areas.
Some of the themes, for example, on Veterans' Day in our
Southwest Region, we will be giving flu vaccine to veterans. We
have other thematic types of exercises that will be going on,
as I said, 19 in all, and we will be taking complete advantage
of the annual flu season being here for mass vaccination.
Senator Akaka. Thank you. Mr. Darnell.
Mr. Darnell. In addition to the October 17 exercise that we
will be participating in with the nonprofits where we test
their continuity of operation planning, we will also be
participating in the Region 3 exercise that Mr. Mauskapf
mentioned, as well, I believe on November 8 and 9. And then we
are also going to be opening up two sites that we will use as
sort of a test of how we would offer vaccines to the larger
public and we will be vaccinating our Department of Health, our
Metropolitan Police Department, and our Fire Department as a
test for that.
Senator Akaka. Thank you. HHS and DHS are the Federal
leaders in pandemic emergency response. But a recent GAO report
found that their respective roles haven't been clarified. Have
HHS and DHS communicated to the 14 jurisdictions of NCR the
roles and the responsibilities of each agency? Dr. Yeskey.
Dr. Yeskey. We at HHS support the role of DHS as the lead
in the overall response to any event in disasters, any
disaster, including pandemic influenza, and we have established
our senior health official structure to mirror what DHS has set
up in establishing principal Federal officials for pandemic
influenza. We have that structure set up and our senior health
officials, along with the DHS principal Federal officials, have
been going out, meeting with State officials, meeting with
local officials, and, among other things, talking about the
structure and how we provide support with the public health and
medical expertise to the overall structure of DHS. So we have
communicated the message to our State and local counterparts of
how we will structure our HHS support to DHS, in their capacity
as overall lead in the event.
Senator Akaka. Mr. Geldart.
Mr. Geldart. Yes, sir. I think building off of what Dr.
Yeskey just commented on, the fact that DHS being the
responsible party for response in a pandemic influenza and
developing the plans, overarching planning, strategic planning
framework for that. I think that has been communicated. I think
it is very clear that the Department of Health and Human
Services has a large role in developing the processes and
procedures that are most important and that most people need to
know from the health perspective. In that, the Federal
departments are receiving guidance from the Department of
Health and Human Services on what they do for their employees,
their critical mission assignments, and how they protect those
folks for continuity within each Federal entity.
So I think in that respect it is very clear for folks, and
on top of that, looking at the NCR in particular right here,
bringing in that person directly working for Dr. Yeskey into
the Office of National Capital Region Coordination and
embedding that person in all of the regional emergency support
function meetings, the planning meetings, the development
meetings that the region does, and having that direct
continuity link from local jurisdictions, State jurisdiction,
to the Federal folks, to HHS is a huge help for my office, I
know, in coordinating between the Federal side and the State
and local side, as well as for the State and locals to have
somebody to turn to directly for answers for that.
Senator Akaka. Dr. Yeskey, public health professionals all
cite the need for alternative standards of care during pandemic
outbreaks. Can you explain to us what would happen for those
requiring medical care for non-pandemic flu reasons during an
outbreak?
Dr. Yeskey. Part of the public health and medical strategy
is to, first, if you look at the epidemic curve of how a
pandemic would look, part of our strategy is to reduce that
overall impact, kind of drop the peak of that curve down a
little bit so we don't have as many patients and reduce the
overall load on hospitals. The second part is to disrupt
transmission so we don't get an immediate burden on our
hospitals but we spread that out over time as the pandemic
moves through the country. So the intent is to reduce the
overall number of patients who seek hospital care and to spread
the burden out over a period of time so hospitals aren't as
overburdened so they can work on taking care of the non-
pandemic patients that show up at their hospitals, as well.
So our plan is really to try and keep those people who
don't--who are infected with the pandemic virus--keep them out
of the hospitals as much as possible and only the people who
really need to be treated in hospitals, get them in there, and
that enables the hospitals to reduce that surge need and to
provide staffing for the non-pandemic patients, as well. Plus,
the development and production of vaccines and the acquisition
of antivirals, help keep that burden off hospitals.
We have published a document, as I said earlier, on
allocation of scarce resources and it walks through the various
aspects of how health care facilities can determine how they
are going to allocate those resources when they are faced with
those situations. So those are several of the strategies that
we have employed in making sure that we try and meet the surge
demand that will occur during a pandemic. We recognize that
this is a tough issue. This is probably one of the tougher
issues in pandemic flu preparations, is medical surge capacity
with staff, with equipment and supplies as well as hospital
services.
Senator Akaka. In reducing impact and disrupting
transmission, you would be working with these jurisdictions.
You mentioned that you would try to keep people out of the
hospitals as you do this. In case people would need hospital
care, and knowing that today many of the hospitals around the
country or in different communities are unable to deal with any
surge for hospital care, are there any plans to deal with that?
Dr. Yeskey. Well, I think States and local communities and
health care systems and hospitals are working on how to provide
surge capacity. And one of the key components of our hospital
preparedness program over the past 5 years is providing funding
to States so they can address surge capacity, they can address
interoperable communications, hospital incident command, and
also address some of the equipment and supply needs that
hospitals might face during a pandemic. So those are the
strategies employed and then we work with the States and the
local health care facilities to develop their surge capacity
planning.
Senator Akaka. Thank you. Mr. Mauskapf, Dr. Yeskey just
mentioned medical surge capacity is going to be a huge
challenge during a pandemic outbreak. According to your
testimony, Northern Virginia, the most populous part of the
State, has a short-term surge capacity of 1,100 beds with a
benchmark of 1,162 beds. However, this shortfall doesn't take
into account long-term surge requirements. How will Northern
Virginia address a long-term medical surge?
Mr. Mauskapf. One of our methodologies obviously is going
to be reaching out to the rest of the State, and we have plans
that we can incorporate bed capacity throughout the State.
Obviously, in a pandemic, if everybody is being affected
simultaneously, that will be difficult.
We have developed four stabilization and treatment-in-place
facilities throughout the State which are triage sites. That
will enhance our capability. They are canvas facilities. They
can be deployed quickly and they can be consolidated and used
together. So those are our mobile resources.
We have also been identifying alternate care centers and we
have established 26 Medical Reserve Corps around the
commonwealth with a very significant number--I think the number
is in my testimony--of medical professionals that would assist
in staffing these alternate care sites and mobile care sites
that I mentioned.
Additionally, with our exercises, we are prepared to
request Federal assistance and DOD assistance. Indeed, we have
Memoranda of Understandings with all of our military bases, and
there is a significant amount of those that we do cooperative
training and exercising with on a regular basis. So we go
through the same process working with the Department of
Homeland Security for our State Emergency Operations Center
requesting Federal assistance. So those would be the
methodologies that we use to enhance our surge capacity.
Senator Akaka. Mr. Darnell, similarly, with the closing of
DC General Hospital a few years ago, DC's reduced hospital
infrastructure raises questions on its ability to meet medical
surge capacity needs. While DC managed to increase bed capacity
by 300 beds last year, that doesn't seem to be able to meet the
potential need during a pandemic. My question to you is what is
DC doing to address short-term and long-term medical surge
capacity needs during a pandemic?
Mr. Darnell. Well, I think the increase in the 300 beds
that you referred to, Mr. Chairman, really is a normal steady
State, if you will. We have already identified, as I testified
earlier, the creation of about 2,300 or so beds in a surge
capacity that we could bring to bear if we had this type of
outbreak. Similar to what Mr. Mauskapf had indicated, we also
have Memoranda of Understanding with our regional partners
where we can identify available beds if we need to use them. We
have also purchased medical field units that we can deploy if
we need to have people hospitalized. We are also working with
the DC National Guard to provide DOD support in the event that
we have to do that, as well. And then, finally, we are
identifying primary care facilities, outpatient primary care
facilities that we could use as inpatient if we need to do
that. So those are some of the steps that we are taking, and
again, as Mr. Mauskapf said, we would also reach out to the
Federal Government for more Federal assistance if we needed it.
Senator Akaka. Thank you. Mr. Darnell, as you know,
children could easily transmit the flu in concentrated places
such as schools, and I know as a former teacher they can become
a central source for the disease. In a large outbreak, it might
be necessary even to close schools. I wonder if you have taken
this into consideration in your planning in DC. If so, how long
would the schools be closed and have you begun planning with
the school departments on alternative ways to provide education
during a pandemic?
Mr. Darnell. Yes, we have discussed what our response would
be, and quite frankly, Mr. Chairman, I couldn't tell you how
long the schools would be closed. In fact, I think the decision
to close schools would be one that we would make with great
care and great caution. My understanding of pandemic influenza
is that unlike normal, if you will, influenza that is seasonal
that generally runs from October to February or March, this
particular strain, the H5N1, has tremendous peaks and valleys
and there are possible times where it could be extremely high,
where it could be extremely low, where it could transmit at
varying rates that, quite frankly, again, as I understand it,
we can't accurately predict.
So I think, first of all, we would take great care in
making a decision to close schools. I would respectfully submit
that one of the things we have to do is really communicate and
educate the school system--educators, parents, and kids--in the
things that they can do to protect themselves and protective
actions that they can take, signs and symptoms of the disease,
of the influenza, if they have it, where they can seek
treatment immediately, as Dr. Yeskey said earlier in his
response to one of your questions, so that we can sort of clamp
down on the spread of it so we don't have to make that type of
decision.
Senator Akaka. In your March pandemic flu exercise, you
mentioned that there were gaps in communication with the K
through 12 schools. I am glad to hear you say that you have
worked with parents, as well, on this. Were there any other
ways that you have addressed the communication gaps in schools?
Mr. Darnell. Yes. One of the things we have done, as I
testified earlier, we have the websites, we have the checklist,
the outreach directly to educators and parents and kids, and we
just recently implemented what we call a Commander Ready
Program that is a part of a Federal program for K through 12.
Right now, we are concentrating on K through the age of 13, and
it is an overall emergency preparedness training curriculum for
kids that pandemic influenza is just one facet of that process.
We also have some informational material that we are going
to be sending out to all of the District residents. Our goal is
to send this information out to 100,000 households within the
District of Columbia, again, that not only focuses on pandemic
influenza, but emergency preparedness in general with that just
being one facet of emergency preparedness.
Senator Akaka. Dr. Yeskey, HHS has responsibility for
overseeing and administering the Strategic National Stockpile
of antiviral drugs and vaccines. Congress appropriated $6.1
billion over 3 years for HHS to work with States on building a
stockpile of Tamiflu, Relenza, and available vaccines. Can you
give us a status, an update on this?
Dr. Yeskey. Sure. A couple things about the medical
countermeasures. We have established several goals that I think
are in my written testimony, but one is to maintain a pre-
pandemic vaccine for about 20 million people. The second goal
is to provide pandemic vaccine to all citizens within 6 months
of pandemic declaration. Our third countermeasure goal is to
provide influenza antiviral drug stockpiles for treatment of
pandemic illness for about 25 percent of the population. And
then the last one is to provide an influenza antiviral drug
stockpile for strategic limited containment, so called
``quenching.'' If an isolated case breaks out, we can use that
treatment to prevent or delay the spread.
We have a couple of strategies for our countermeasures, the
medical countermeasures for pandemic influenza. One is the
advanced development piece of that, and that is to look at
alternate ways to be less dependent on egg-based vaccination
cultures, and we are looking at developing cell-based
production of vaccine that gives us more vaccine production
capability. We have also looked at antigen-sparing vaccine with
the use of adjuvants. Adjuvants are materials added to vaccines
that improve their efficiency, thus requiring a lesser dose for
the vaccination. That would give us a bit more vaccine in our
stockpiles. We are also looking at new antivirals. We currently
have two in our stockpile. We are looking at production of
other new antivirals.
We are also looking at Federal Stockpile acquisitions. That
is the second part of our strategy. As I mentioned, we were
looking at about 81 million treatment courses for the
antivirals. Currently, we have about 37.5 million in the
stockpile, with an appropriations request for another 12.5
million. States have also been given the responsibility of
stockpiling about 30 million doses, and I think the last
numbers that I saw, they have purchased about 15 million
treatment courses. Money has been made available so States get
a subsidy on the purchases and they are also able to purchase
at the Federal price.
The third piece that we have developed, or the third
strategy that we have looked at, is infrastructure building,
trying to look at how we can increase the domestic
infrastructure for vaccine production. We have invested money
in the retrofitting of existing vaccine production facilities
to specifically address some of the new cell-based
technologies. So that, in a nutshell, is a summary of our
progress with countermeasures.
Senator Akaka. Thank you. Dr. Yeskey, CDC has the authority
from the FDA under the Shelf Life Extension Program to store
antiviral drugs and vaccines for a longer period of time than
States or local governments. It must be a tremendous additional
cost for States to replenish their purchases every few years.
How do you decide when pandemic-related antiviral drugs and
vaccines are stored by the State and when they are stored by
the CDC?
Dr. Yeskey. A little bit about the Shelf Life Extension
Program. That is an interagency agreement between the
Department of Defense and the Food and Drug Administration, and
the arrangement is that when drugs are stored appropriately--
for the agencies that participate in this--when the drugs
approach their shelf life termination, the FDA tests them to
see how potent they remain in that period of time and then will
grant, if they meet the standards established by CDC--and
again, this is a superficial explanation of this process--but
nevertheless, the FDA tests it and then assigns an additional 2
years or so shelf life extension for products that meet their
requirements--stored appropriately, maintained appropriately,
and maintain their potency during testing. The agreement is
that any material that does not meet those requirements when it
is tested gets destroyed.
The process is fee-for-service and currently the VA, Health
and Human Services--through the Stockpile--and DOD participate
in this process. So that is the process that occurs, and it is
all done through the Defense Medical Standardization Board.
For States to participate in this program would require a
significant increase in the demand on FDA resources and on the
Department of Defense to administer this. At the direction of
the HSC, an interagency panel met to look at whether we could
offer this program to the States. For the present time, the
recommendation out of the panel was that they would not be able
to accommodate States in the Shelf Life Extension Program, but
they have not absolutely ruled that out, to the best of my
understanding. So they are going to continue to look at this to
see if there is a mechanism by which States can participate in
a Shelf Life Extension Program. But for now, in the DOD-FDA
Shelf Life Extension Program, they do not.
Senator Akaka. Thank you. Mr. Mauskapf and Mr. Darnell, you
have heard Dr. Yeskey mention about stockpile. Can you provide
us with a stockpile update for Virginia and for DC? Mr.
Mauskapf.
Mr. Mauskapf. Virginia has received the highest rating from
CDC, a green rating, for the last 3 years running. We will have
our State review later on in October for our fourth year and we
anticipate a like situation.
We have developed what I think is a pretty imaginative set
of partnerships with private sector. A national transportation
company has undertaken a ground contract for all State agencies
within the Commonwealth and that includes--the RFP that went
out included that to get that contract, they must also deliver
our stockpile, and, in fact, they were signed on to that and
that is now part of their contract.
We have a network of five Receive Stage and Store sites
around the Commonwealth to receive the stockpile. We are
working with Wal-Mart at their distribution center in
Harrisonburg as a potential new site. We have identified over
300 Points of Dispensing (PODs), around the Commonwealth. We
have enlisted the assistance of 26 Medical Reserve Corps in
helping to dispense our stockpile. We also have tested in every
single one of the 35 health districts twice a year either a
mass vaccination or a mass dispensing exercise.
Under the Cities' Readiness Initiative in the three regions
that are CRI areas, the National Capital Region, Metropolitan
Richmond, and Hampton Roads, we have done asymmetric dispensing
exercises, which include drive-through exercises, school bus
delivery of meds, bookmobiles. We are working now with major
newspapers in the three regions to develop our printed material
and we have agreements with them to develop the printed
material that is attendant to dispensing within 20 hours of
request. So I think we are in pretty good shape for the
stockpile.
Senator Akaka. Thank you. Mr. Darnell, will you update us
on your stockpile for DC?
Mr. Darnell. Yes, sir. We have about 45,000 treatment
regimens that we have stockpiled. We have the green rating from
the CDC, as well, green minus for the receipt and distribution
of the Strategic National Stockpile, and similar to my
neighbors in Virginia, we have also exercised how we would
distribute the stockpile, identified the sites where we would
do that. As I indicated earlier, we will have a test of that in
November as we do that with some of our public safety personnel
on how we would carry that out. And so we continually take a
look at that. As Chris Geldart indicated earlier, as a part of
our shelter and evacuation plan of identifying sites and
distribution shelters and those different types of things, that
is a part of that process, as well, for the District, let alone
for what we are doing for the larger NCR.
Senator Akaka. Thank you. Mr. Darnell and Mr. Mauskapf, as
I mentioned in my opening statement, there are 20 million
tourists who visit the NCR every year. There are also 130,000
students in the region who may not be permanent residents. Are
you taking non-resident populations into account, Mr. Mauskapf?
Mr. Mauskapf. Absolutely. We don't ask to see a State-
specific identification card. With our border States, we have
entered into agreements. If we open our PODs and they are
closer for some of their citizens, there is no problem for them
coming across the border. We have done, as recently as last
October, a joint exercise with the District and with Maryland.
We have received the stockpile and we have worked together in
the management of the stockpile and the distribution to the
PODs throughout the National Capital Region. There is full
understanding that we will be mutually supporting in the event
of such a requirement.
Certainly in Virginia Beach and Williamsburg and areas
where we have huge populations of visitors during the tourist
season; all our colleges and universities have been integral to
our planning and exercising and certainly they are all
considered and will be part of the distribution and dispensing.
Senator Akaka. Thank you. Mr. Darnell?
Mr. Darnell. Yes. I would just echo Mr. Mauskapf's
comments, as well. The exercises that he referred to, we will
have participated in that. We all have Memoranda of
Understanding that we would support each other in the event of
this type of outbreak.
With regard to the colleges and universities that are
located within the District of Columbia, we have what we call a
College and University Consortium where we meet with them on a
monthly basis to discuss emergency preparedness issues in
general, and again, this is one facet of it. So we certainly
would include students in that equation if they needed to
receive treatment.
Again, we have a close working relationship with the DC
Greater Board of Trade as well as the DC Chamber of Commerce
and the hotel and hospitality industry, so again, as I stated
earlier, if there was an outbreak, we would be able to utilize
their resources to track individuals who come in and out of the
city and as they leave so that we can contact them in case they
were infected or had the potential to become infected.
Senator Akaka. Mr. Mauskapf, according to CDC guidance, the
States may elect to request assistance from the Postal Service
to aid in the direct delivery of antiviral medications to
residences. Would this work for something as big as pandemic
flu, or have you exercised this or dealt with the Postal
Service on this?
Mr. Mauskapf. We have done joint planning with the Postal
Service in the National Capital Region under the Cities'
Readiness Initiative Program. It is the most efficient and
effective means to get medications out to the citizens. The
issue with delivering through the Postal Service is security. A
requirement from the Postal Service's unions is that they have
an armed guard riding along with them if they are, in fact,
delivering meds.
During a pandemic or during any major event, you can
imagine the requirements that are going to be levied upon law
enforcement entities, so it is difficult to assure the Postal
Service that we will be able to have an armed guard with each
one of their mailmen and delivery vehicles. We have looked at
mobilizing the Guard in the Commonwealth. We have looked at
mobilizing the Department of Corrections. And we have worked
with local law enforcement agencies. We agree that is a viable
methodology. The issue is going to be whether or not we will be
able to provide the law enforcement to support the union
requirement.
Senator Akaka. Mr. Mauskapf, are there plans to provide the
letter carriers--and you mentioned the guards--but do you have
plans to provide letter carriers with police protection?
Mr. Mauskapf. That is what I am saying, that is the issue,
whether or not there is sufficient law enforcement or Guard or
Department of Corrections armed guards to provide--the
requirement is 1,100 when we modeled this. It is a requirement
for 1,100 for the Virginia portion of the National Capital
Region to handle all the routes, if they are doing two routes a
day. They have to cease all mail delivery, do two routes a day
of nothing but medications. So that is a requirement of 1,100
personnel that would be able to do that. Given the other
requirements upon law enforcement at that time, that is going
to be a tough nut to crack.
So we are continuing to look at that, and one of the
initiatives that we have studied is going to the Federal
Government for the National Capital Region and requesting the
assistance of Federal law enforcement agencies to support us in
the event of doing this. That has not been developed any
further than the idea level right now.
Senator Akaka. Thank you. The Federal Government is a huge
partner in the NCR. I would like to hear from all of you on how
OPM and local Federal Government agencies have been working
with you on coordinating their pandemic response plans. Dr.
Yeskey.
Dr. Yeskey. At HHS, we have been working on our continuity
of business, continuity of operations plans by trying to work
through identifying our essential functions that we will need
to carry out during a pandemic with a reduced workforce. We are
also looking at identifying those critical personnel and those
personnel who can work from home and then looking at the
mechanisms by which we can enable them to work from home and
carry out those functions.
I can't comment on the interactions with OPM since this
continuity of business is handled outside of my office, but I
can get that information for you for the record.
Senator Akaka. Thank you. Mr. Geldart.
Mr. Geldart. Yes, sir. As I mentioned earlier, and to lead
off of what Dr. Yeskey just said, to tail onto that, the
Federal employees that work within all of these departments and
agencies are residents within this region, residents within the
States somewhere within this region. So from that perspective
as each of the States are doing their planning and localities
are doing their planning, within that are the people that come
to work here. However, the higher level of planning that needs
to happen, and this is where Dr. Yeskey was going towards, is
those critical mission areas, those things that the Federal
Government must continue to do to function.
From the Federal Reserve Board perspective, to give an
example, the Federal Reserve pays us all and they also pay many
State employees. That is part of their mission. That would need
to continue. So as Dr. Yeskey says, each agency is looking in
to see what are those employees that consist and make up that
critical mission area, and then what is that continuity of
business plan that we have as an agency to ensure that those
folks are being addressed so that we can maintain those
critical mission areas.
As the individual departments and agencies come up with
those plans, that is going to be needed to take a look at are
they doing prophylaxis? Are they looking at doing the Tamiflu
things that were mentioned before, and are those contracted or
are those stored? Those kind of things obviously are going to
be needed to be coordinated throughout the region.
Senator Akaka. Mr. Mauskapf.
Mr. Mauskapf. We have done extensive work with the Federal
Reserve Bank in Richmond, and as recently as 2 months ago the
three of us met with the Federal Reserve Bank and the Board of
Governors here in DC to discuss this very issue. We have got
Memoranda of Understanding with each of our military bases, and
when I talked about our antiviral distribution, I mentioned
that we do it through the TRICARE clinics and military clinics
assigned to them.
As Mr. Geldart said, the Federal employees are residents of
our communities and certainly we have planned for their
coverage. The issue comes when we talk about continuity of
government, continuity of operations planning and whether or
not there are expectations for early delivery of medications,
be they prophylaxis, antivirals, or flu vaccine when it becomes
available. How is that going to be happening and what is the
requirement? Identification of key personnel and the
synergizing, if you will, of the Federal plans with our
distribution and dispensing plan is key, and that has yet to
happen with most of the agencies.
Senator Akaka. Thank you. Mr. Darnell.
Mr. Darnell. I would echo those comments and I think I
would also add that we probably need, or not probably, in my
opinion, we need more transparency in terms of OPM and what
their plans are, under what conditions those plans will be
implemented, and how we interact with that. Quite frankly, it
would probably be nice just to get them to let us know when
they are going to let people leave work early, as we are
concerned, in the District of Columbia.
So in this case, in particular, what telework plans do they
have if they are going to allow people to work regular hours?
Again, as Mr. Geldart indicated, what are their mission-
critical agencies or personnel that are going to continue to
work, non-essential personnel who won't be working? Those are
shifting patterns that affect our transportation systems, that
affect our businesses, all those different types of things. So
we just need more transparency with the Federal Government on
those types of things.
Fortunately, I think we are headed in that right direction.
As Mr. Mauskapf said, we met 2 months ago with the Federal
Reserve Board Governors. We are actually, as the District of
Columbia Government, we are going to be meeting with my
counterparts at OPM and on Capitol Hill in the Legislative
Branch to discuss some other issues and this will be one topic
that we bring up, as well.
Senator Akaka. Thank you. Dr. Yeskey, the cost of treating
patients infected with pandemic flu over time is going to be
considerable, especially in light of the fact that 46.6 million
Americans are without health insurance. Have you given any
thought to the costs of care for those who do not have health
insurance?
Dr. Yeskey. Our overall strategy, again, is to try and keep
people out of hospitals by preventing the transmission of
disease. So part of our strategy is to minimize the number of
people who are infected.
With regard to the health care costs associated with the
surge in patients who might seek hospital care, that is an area
that is not covered within my office. But again, I would have
to go back and talk to our CMS folks and try and provide you
with an answer to that.
Senator Akaka. Well, thank you. Thank you very much, all of
you. You have been helpful to the Subcommittee in dealing with
the pandemic flu. I am impressed by the work that our witnesses
have done, but it is clear that we need to do more to prepare
for a potential pandemic flu outbreak in the National Capital
Region. I look forward to continuing this discussion on
preparedness and staying informed about what additional
progress is being made.
I want to thank you again for your responses. I appreciate
you being with us today. The record will remain open for 1 week
for any statements or additional questions Members may have.
With that, this hearing is now adjourned.
[Whereupon, at 11:30 a.m., the Subcommittee was adjourned.]

FORESTALLING THE COMING PANDEMIC:
INFECTIOUS DISEASE SURVEILLANCE
OVERSEAS

----------

THURSDAY, OCTOBER 4, 2007

U.S. Senate,
Subcommittee on Oversight of Government
Management, the Federal Workforce
and the District of Columbia,
of the Committee on Homeland Security
and Governmental Affairs,
Washington, DC.
The Subcommittee met, pursuant to notice, at 2:32 p.m., in
Room SD-342, Dirksen Senate Office Building, Hon. Daniel K.
Akaka, Chairman of the Subcommittee, presiding.
Present: Senators Akaka and Coburn.

OPENING STATEMENT OF SENATOR AKAKA

Senator Akaka. I call this hearing to order. This is a
hearing of the Subcommittee on Oversight of Government
Management, the Federal Workforce, and the District of
Columbia, and I call it to order. I want to welcome our guests
and thank you very much for being here.
This is the third in a series of hearings that my
Subcommittee is holding to ensure that we are as well prepared
as possible to handle the possible pandemic flu. Last week, we
examined the role of the Federal Executive Boards in assisting
in pandemic flu preparation, and earlier this week we examined
National Capital Region efforts to prepare for such a public
health emergency.
Today's hearing focuses on efforts to project our defenses
beyond our borders. The Government Accountability Office will
also be releasing a report today entitled ``Global Health: U.S.
Agencies Support Several Programs to Build Overseas Capacity
for Infectious Disease Surveillance.'' That report reviews
several of the programs we will hear about during this hearing.
The consensus among public health specialists is not if
there will be another pandemic influenza outbreak in the United
States, but when and if we will be prepared when it happens. A
pandemic of avian influenza, the disease being most closely
monitored by the public health community, as you know, could
kill hundreds of millions of people throughout the world and
alter the balance of power within and between nations. That is
how huge it is.
As we will hear from Colonel Erickson shortly, a 2001
National Intelligence Estimate concluded that emerging
infectious diseases are a global security issue, destabilizing
countries and institutions, impacting economic growth, and
obstructing trade.
Experts agree that the way to reduce the impact of a
pandemic disease is to identify, isolate, and treat it at the
place it emerges. Similar to our efforts to turn back the
threat of terrorism, it is better to defeat this enemy in its
homeland and not in ours.
The topic of our hearing today, global disease
surveillance, seeks to do just that. By identifying and
isolating diseases early and where they first appear, we can
minimize the potential impact on the United States by
preventing the spread beyond its original borders. If they do
spread, the early information provided by surveillance systems
allows us to be better positioned to take early steps to
protect Americans.
The last major flu pandemic to hit the United States was
the 1968-69 Hong Kong flu outbreak, which caused approximately
34,000 deaths. Since then, we have become more vulnerable to
dangerous diseases that move among countries. Increased
international travel coupled with the impact of climate change,
economic development, land use, and in some cases the breakdown
of public health are all factors in the emergence of new and
novel strains of disease that impact many countries.
The rapid spread of severe acute respiratory syndrome in
2003 demonstrated how a disease outbreak can pose a threat
beyond the border of the country in which it originates. The
impact of another severe pandemic flu outbreak could devastate
the United States and, in particular, the U.S. economy.
In a March 2007 report, the Trust for America's Health
estimated that a severe pandemic flu outbreak would cause a
drop in the U.S. gross domestic product of roughly 4.25 percent
to 6 percent. The Trust defines a ``severe outbreak'' as one
that would make approximately 90 million Americans ill and
cause roughly 2.25 million deaths. An outbreak of this severity
could almost certainly lead to a major economic recession.
According to the Congressional Budget Office, a contraction of
this size could cause the second worst recession in the United
States since World War II.
Hawaii has taken a lead in ensuring its residents and
visitors are protected and prepared to respond swiftly to any
pandemic disease outbreak. For example, Hawaii became the first
State to screen incoming airline passengers on a voluntary
basis. Health officials have stockpiled enough antiviral drugs
to treat a minimum of 25 percent of the resident and visitor
population. The Hawaii Department of health is developing a lab
with the capability to test for avian flu and other flu
strains. Hawaii has also established a Medical Reserve Corps to
recruit volunteers to assist in a public health emergency.
In March, the Hawaii Department of Health launched a public
awareness campaign called ``Share Aloha, Not Germs'' to raise
public awareness of pandemic threats and the steps everyone
could take to minimize them. And this past July, Hawaii
conducted the most ambitious pandemic flu exercise of its kind.
The exercise, called ``Operation Lightning Rescue,'' involved a
fictional commercial airplane carrying a number of suspected
avian flu victims which crashed on Midway atoll while traveling
from Jakarta to Mexico City. The exercise trained local, State,
and Federal officials in limiting the impact of a flu outbreak.
It is widely accepted that the key to control of any
pandemic outbreak is early identification and rapid response.
The earlier a dangerous disease is identified and steps are
taken to respond, the higher the probability that such
interventions, including development of vaccinations can be
successful. The global disease surveillance activities we will
examine in this hearing can help forestall a potential pandemic
by identifying those threats where they first emerge in other
countries.
While international travel and other factors have changed
the way emerging disease spreads among nations, the nature of
emerging disease itself has also changed. Now, more than ever,
the majority of diseases capable of creating a pandemic have
come from animals and spread to humans. We need only look at
some of the most recent global health threats to find evidence
of this trend. West Nile, HIV, SARS, and most recently, avian
influenza, or bird flu, are all diseases that have originated
in animals and then spread to humans to create global health
emergencies. This means that we must not only monitor new human
diseases, but also those that arise in all types of animals.
Emergence of the West Nile virus in 1999 in New York City
is a clear example of the value of bringing the human health
and animal health communities together. At first, the public
health community was focused on reports of elderly people
coming down with similar symptoms, but when flamingos and black
crows began dying at the Bronx Zoo around the same time, a
veterinary pathologist there, Dr. Tracey McNamara, made the
connection between the sick birds and the sick people. Her
analysis provided the breakthrough in diagnosing West Nile
virus, a disease that had never before been seen in the Western
hemisphere.
Having just observed National Preparedness Month, I can
think of no more important issue than situational awareness, an
essential element of homeland security. Situational awareness
must include being aware of emerging infectious diseases before
they devastate our communities.
So I look forward to hearing from all of our witnesses
about their work in contributing to our awareness of those
potential threats to our homeland. Again, I want to thank our
witnesses for being here today to discuss this important issue.
And I want to welcome the witnesses to this Subcommittee today:
Dr. Ray Arthur, Director of the Global Disease Detection
Operations Center at the Centers for Disease Control and
Prevention at HHS; Dr. Kimothy Smith, Director of the National
Biosurveillance Integration Center at the Department of
Homeland Security; Colonel Ralph Erickson, Director of the
Department of Defense Global Emerging Infections System at
Walter Reed Army Institute of Research; Dr. Kent Hill,
Administrator for Health at the U.S. Agency for International
Development; and David Gootnick, International Affairs and
Trade, U.S. Government Accountability Office.
I want our witnesses to know that it is the custom of the
Subcommittee is to swear all witnesses, and I would like to ask
all of you to stand and raise your right hand. Do you solemnly
swear that the testimony you are about to give this
Subcommittee is the truth, the whole truth, and nothing but the
truth, so help you, God?
Mr. Gootnick. I do.
Mr. Arthur. I do.
Mr. Smith. I do.
Colonel Erickson. I do.
Mr. Hill. I do.
Senator Akaka. Thank you. Let it be noted for the record
that the witnesses answered in the affirmative
Before we start, I want you to know that your full written
statements will be part of the record. I also would like to
remind you to keep your remarks brief, given the number of
people testifying this afternoon.
So, again, we appreciate your being here. Thank you for
being here, and I will ask Mr. Gootnick to begin.

TESTIMONY OF DAVID GOOTNICK,\1\ DIRECTOR, INTERNATIONAL AFFAIRS
AND TRADE, U.S. GOVERNMENT ACCOUNTABILITY OFFICE

Mr. Gootnick. Thank you very much, Mr. Chairman.
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\1\ The prepared statement of Mr. Gootnick appears in the Appendix
on page 184.
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Mr. Chairman, I am pleased to discuss GAO's recent review
of U.S. programs to build overseas capacity for infectious
disease surveillance. As you have well stated, Mr. Chairman,
H5N1 influenza in birds has the potential to evolve to a
disease transmitted from person to person, setting the stage
for a human flu pandemic.
As you said earlier, SARS in Asia demonstrated, amongst
other things, that international response to an outbreak is
dependent on cooperation from affected countries, and West Nile
virus highlighted the need for improved links between human and
animal surveillance.
In this environment, the United States has a key interest
in building capacity within developing nations to identify and
respond to outbreaks of infectious diseases. Building and
sustaining this capacity poses considerable challenges,
including shortages of trained personnel, limited lab
capability, and weak or deteriorating infrastructure, including
facilities, roads, and communications, in the overseas
environment.
In this context, you asked GAO to report on: One, the key
U.S. programs that build capacity for infectious disease
surveillance within developing nations; and, two, agencies'
efforts to monitor the progress of these programs.
We identified a set of activities generally embedded in
larger programs that also conduct research, support outbreak
investigations, link with larger networks, and, in the case of
DOD, enhance readiness and force protection. In addition, even
these programs which we have reviewed exist in a larger context
that includes disease-specific surveillance, such as vertical
systems for HIV, polio, and, increasingly, avian influenza.
From 2004 to 2006, CDC, USAID, and DOD obligated about $84
million to capacity-building efforts. CDC's GDD Initiative is
establishing centers of excellence overseas that, amongst other
things, strengthen labs, develop active surveillance systems,
and train local health workers. CDC and AID together support 2-
year field epidemiology training programs in 24 countries.
These programs have trained over 350 epidemiologists and lab
professionals. For example, CDC's Central American program
reports that it has trained, placed, and supported 58 master's
level epidemiologists and provided field-based training to a
larger cadre of health workers at local levels. AID and CDC
also provide technical assistance and training to African
nations to integrate disease-specific surveillance systems and
prepare to meet the broadened national requirements of
recognition and response as established by the revised
international health regulations.
DOD, through its GEIS program, has funded more than 60
small-scale projects for surveillance and capacity building,
again, within their larger mission of readiness and force
protection. For example, in parts of Southeast Asia, GEIS has
disseminated a syndromic surveillance system designed for
resource-poor settings.
Finally, AID independently funds a number of activities to,
for example, build capacity and develop tools for monitoring
and evaluation.
Regarding coordination, we found that CDC and AID through
cooperative agreements, joint funding, and staff details
frequently work in partnership. DOD and CDC report that
collocation of major operational centers, for example, in Kenya
and Egypt, facilitates communication.
In a study released this week, the Institute of Medicine
observed that collaboration between CDC and DOD is critical to
ensure the most effective use of resources targeting avian
influenza. The IOM recommended, amongst other things, that DOD
further strengthen this critical linkage for emerging
infectious diseases.
Individual programs monitor activities, such as the number
of trained individuals and the number of outbreak
investigations conducted by their trainees. They recently began
efforts to evaluate the larger impact of these programs, but
have yet to report results. Evaluating these programs will be
challenging for a number of reasons.
First, capacity efforts are generally collaborations within
a host country health ministry, making impact of a program
difficult to isolate.
Second, data quality and competing priorities may
complicate efforts to evaluate programs.
And, finally, demonstrating program impact is very
difficult in the complex and changing environment in which
these programs operate.
In closing, Mr. Chairman, a number of activities are
underway. However, outside of the vertically oriented disease-
specific systems, support for broadly targeted assistance to
build capacity for infectious disease surveillance has been
limited. Numerous studies and experts have noted that
investment in these programs is small compared to the risks of
emerging infectious diseases and the challenges associated with
sustained preparation and effective response.
Mr. Chairman, this concludes my statement. I am happy to
answer your questions.
Senator Akaka. Thank you very much, Mr. Gootnick.
Now we will hear from Dr. Arthur.

TESTIMONY OF RAY ARTHUR, PH.D.,\1\ DIRECTOR, GLOBAL DISEASE
DETECTION OPERATIONS CENTER, CENTERS FOR DISEASE CONTROL AND
PREVENTION, U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Mr. Arthur. Good afternoon, Chairman Akaka. My name is Dr.
Ray Arthur, Director of CDC's Global Disease Detection
Operations Center. I have 15 years of specialized experience in
detecting and responding to global disease outbreaks, including
6 years at the World Health Organization and 5 years at the DOD
Medical Research Unit in Cairo, Egypt. I am pleased to discuss
CDC's global health investments that build capacity for disease
detection and response.
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\1\ The prepared statement of Mr. Arthur with attachments appears
in the Appendix on page 203.
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CDC has approximately 200 staff assigned to 50 countries
throughout the world and supports an additional 1,200 locally
employed staff in these countries. As you have indicated, SARS
demonstrated that a highly infectious disease can quickly
spread around the world. In 2004, recognizing this, the U.S.
Congress provided funding for CDC to establish the Global
Disease Detection Program. The GDD program built on CDC's
health strengths and brought together three established
programs: The Field Epidemiology Training Program that was just
mentioned, which provides training on the investigation and
control of outbreaks; the International Emerging Infections
Program, which integrates disease surveillance, research, and
prevention and control activities; and, third, influenza
activities, including the development of surveillance capacity.
In addition, the GDD Program coordinates with other global
health programs at CDC, such as HIV/AIDS, polio, and measles,
to leverage resources that contribute to outbreak detection and
response. As an example of this capacity, one of the first
places to identify the SARS coronavirus was a global polio
network laboratory in China.
Earlier this year, staff from the CDC Global AIDS Program
in Nigeria, played a critical role in the diagnosis of the
first human case of avian influenza in Sub-Saharan Africa. The
GDD Program then utilized its regional resources to deploy
staff and continue the response activities.
The central focus of the GDD Program is the establishment
and expansion of the GDD Centers mentioned by Mr. Gootnick.
Strategically positioned around the world, these centers focus
on five activities in key areas: Outbreak response,
surveillance, training--both epidemiology and laboratory--
research, and networking. CDC currently operates five centers--
two mature centers in Thailand and Kenya, and three developing
centers in Guatemala, China, and Egypt.
The GDD Operations Center serves as CDC's central
coordination point for international outbreak information.
Information is collected from many sources, including GDD
centers, other CDC programs, WHO, DOD, USDA, USAID, Homeland
Security, the State Department, and Georgetown University's
Project Argus, among others. CDC scientists analyze the
information, determine the public health threat, and guide the
appropriate level of response.
For example, CDC and other international partners are
currently responding to an outbreak of Ebola in the Democratic
Republic of Congo, DRC. In Collaboration with Argus, CDC began
tracking reports of unexplained illness in DRC in late August
and alerted WHO and other partners once this was determined to
be a significant health threat. CDC has deployed a physician to
provide an assessment of the situation and, with support from
the CDC Global AIDS Program in Kinshasa, to guide a larger
response. Shortly thereafter, on September 10, a CDC lab
confirmed Ebola. CDC then deployed a response team comprised of
nine scientists, and we continue to work closely with the
Ministry of Health, WHO, and other partners to stop this
outbreak.
During 2006, the GDD centers collectively responded to more
than 144 disease outbreaks, including avian influenza,
hemorrhagic fevers, meningitis, cholera, plague, and
unexplained sudden death. CDC currently considers influenza to
be the most urgent threat to human health. Bilaterally, and
globally through WHO, CDC is providing support to over 40
countries to advance the capacity to detect influenza viruses
with pandemic potential. CDC is one of four WHO collaborating
centers for influenza. As such, CDC serves as a global resource
and reference center for the WHO Influenza Surveillance
Network. Between 2003 and 2007, CDC received 1,445 suspect
avian influenza specimens through this system, of which 508
were positive, and also received nearly 20,000 non-avian
influenza viruses through this network.
In addition, CDC has conducted numerous training programs
to prepare rapid response teams in Africa, Asia, and Latin
America. Since 2003, CDC has responded in two and helped
contain many outbreaks of avian influenza globally, and all
responses were initiated within the target goal of 48 hours.
CDC looks forward to continued collaboration with our
partners to implement additional activities that will further
enhance capacity.
This concludes my testimony, and I would be pleased to
answer any questions you may have.
Senator Akaka. Thank you very much, Dr. Arthur.
At this time, before I call on Dr. Smith, we are glad to
have Senator Coburn here.

OPENING STATEMENT OF SENATOR COBURN

Senator Coburn. Thank you, Mr. Chairman.
Senator Akaka. Do you have a statement you would like to
make?
Senator Coburn. No. I may put a statement in the record.
Thank you, sir.
Senator Akaka. Thank you, Senator.
Dr. Smith, will you please proceed with your testimony?

TESTIMONY OF KIMOTHY SMITH, D.V.M., PH.D.,\1\ ACTING DIRECTOR,
NATIONAL BIOSURVEILLANCE INTEGRATION CENTER, CHIEF SCIENTIST,
OFFICE OF HEALTH AFFAIRS U.S. DEPARTMENT OF HOMELAND SECURITY

Mr. Smith. Certainly. Thank you, sir. Mr. Chairman, Members
of the Subcommittee, I am Dr. Kimothy Smith, Acting Director of
the National Biosurveillance Integration Center for the
Department of Homeland Security. I appreciate this opportunity
to discuss with you today the advances in the program and
particularly the incorporation of global biosurveillance data
and wild animal information into our biosurveillance products.
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\1\ The prepared statement of Mr. Smith appears in the Appendix on
page 220.
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Our mission to leverage and integrate existing
biosurveillance capabilities to provide early recognition of
biological events of potential national significance was
mandated initially by Homeland Security Presidential Directives
9 and 10. Additionally, the newly signed Public Law 110-53
further codifies our cross-domain, integrative biosurveillance
mission and gives us clear guidance for our efforts.
Today I will provide a continuing vision for the NBIC,
highlight for you the advances we have made, and provide you
with the current status of the program. Additionally, I will
address our integration and interface with sources of global
biosurveillance and wild animal biosurveillance information.
Last, I will mention the challenges that remain before us in
this effort and my view for onward movement towards meeting the
mandates the country has lain before us.
It is essential that I convey to you that NBIC is more than
an information technology solution to the Nation's integrated
biosurveillance challenge and is unique in both mission and
breadth. The heart of the NBIC, though, is relationships
between people and the agencies and organizations they
represent. These are relationships vital to obtain access to
the valuable, often sensitive, and sometimes classified
information collected and used by the NBIC partners. NBIC does
have and will continue to pursue relationships with personnel
from a wide variety of Federal agencies and other relevant
entities. We are developing relationships with various State
intelligence fusion centers and with entities such as
Georgetown University's Argus Project, which will be
represented here today.
As for where we stand today, it should be noted that our
center is operational today. Though not at its full operational
capabilities, we have had a 24-hour-a-day, 7-days-a-week
national biosurveillance watch desk up and working since
December 2005, responding to real-world events. Facilities have
been acquired and personnel requirements have been finalized,
with two-thirds of our personnel requirements filled to date.
Six significant Federal partners have already signed
memorandums of understanding for mission support and
integration with five others in an effort to best determine
their abilities to contribute.
Interagency agreements and memorandums of agreement have
also been developed for the integration of subject matter
experts from both the Center for Disease Control and Prevention
and the Armed Forces Medical Intelligence Center. These are
just some of the significant advances I would like to highlight
for you that our program has.
Currently, the acquisition process for our biosurveillance
program is based on monitoring sources for significant
information to be used in product development for dissemination
to decisionmakers and key stakeholders, and includes
information that is global in scope. Key sources in use include
government agency reports and open-source information, such as
Argus, the Office International des Epizooties, or OIE; the
Centers for Disease Control and Poverty Global Disease
Detection Program--Ray Arthur sitting next to me; the World
Health Organization; and the Department of Defense GEIS
program, whom you will hear from in a moment, among others.
Another important function of NBIC is the integration of
wildlife biosurveillance information as a potential key early
indicator of bioevents. Government organizations like the
Department of Interior, the Department of Agriculture, and the
U.S. Geological Survey, along with such information networks
such as the Global Avian Influenza Network for Surveillance
(GAINS), that receives support from my colleagues here from
USAID as well as CDC, as well as the International Species
Information System/Zoological Information Management System
(ISIS/ZIMS), all play a key role in monitoring and reporting
what could be very early indicators of a significant bioevent
by way of our wildlife.
To this end, we have clear interest in and intend on
supporting, where possible, the ISIS/ZIMS efforts, as well as
deepening our relationship with our GAINS colleagues for
enhanced information sharing beneficial to the broader
biosurveillance community.
Mr. Chairman and Members of the Subcommittee, as with any
maturing program there are challenges. While continuing to move
forward to meeting our goals, we are cognizant to keep a heads-
up posture and maintain a broad vision with realistic
assessment of the biosurveillance mission to assure success. We
can achieve success in this critical mission with your support
and that of our interagency partners and the members of the
biosurveillance community, such as those testifying here today.
Thank you for your time, and I look forward to your
questions.
Senator Akaka. Thank you very much, Dr. Smith.
And now we will hear from Colonel Erickson. Will you please
proceed?

TESTIMONY OF COLONEL RALPH L. ERICKSON, M.D., DrPH.,\1\
DIRECTOR, DEPARTMENT OF DEFENSE GLOBAL EMERGING INFECTIONS
SURVEILLANCE AND RESPONSE SYSTEM (DOD-GEIS), U.S. DEPARTMENT OF
DEFENSE

Colonel Erickson. Mr. Chairman. Senator Coburn, Members of
the Subcommittee, thank you for inviting me to speak with you
today. I am Colonel Ralph Erickson, Director of the DOD Global
Emerging Infections Surveillance and Response System, a program
which is abbreviated DOD-GEIS.
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\1\ The prepared statement of Colonel Erickson appears in the
Appendix on page 228.
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The DOD-GEIS was created in 1996 by a Presidential Decision
Directive that expanded the role of the DOD to address threats
to our Nation and others posed by emerging and re-emerging
infectious diseases.
DOD-GEIS has four goals, of which the first, surveillance
and detection, is the primary area of concentration. Anchored
by five robust overseas laboratories in Thailand, Indonesia,
Kenya, Egypt, and Peru, the DOD-GEIS team operated in 77
different countries worldwide in fiscal year 2006 and fiscal
year 2007.
Our efforts to improve outbreak detection including
electronic surveillance systems which apply computer and
information technology in places with very few resources. These
systems are currently operational in Indonesia, Laos, and Peru.
Other recent accomplishments of DOD-GEIS are these:
Our Rift Valley Fever risk prediction project provided us
warning of the Rift Valley Fever epidemic in East Africa in
September 2006, 2 months before the outbreak began. The Navy's
lab in Cairo, Egypt, responded to influenza outbreaks in Iraq
and Afghanistan. Not surprisingly, this same lab has become the
WHO influenza regional reference laboratory for the Eastern
Mediterranean region and is working in many countries in the
Middle East and Central Asia. In all, DOD-GEIS partners are
currently collecting influenza isolates at 273 distinct sites
in 56 different countries. DOD-GEIS works closely with other
U.S. Federal agencies who are also engaged in the surveillance
of infectious diseases. Of note is the CDC-DOD Working Group.
To further enhance our integration of DOD-GEIS surveillance
efforts globally, we have a military medical officer assigned
to the World Health Organization in Geneva, Switzerland. Our
DOD-GEIS network is replete with talented physicians,
veterinarians, entomologists, and laboratory professionals
drawn from all of the Uniformed Services where the culture of
One-Health/One-Medicine is already well established.
As an example of this, since 2003, the Navy's lab in Cairo,
Egypt, and the Army's lab in Nairobi, Kenya, have worked with
the Centers for Disease Control and Prevention and host Nation
regional partners to collect wild bird surveillance samples to
detect circulating strains of avian influenza virus.
Incidentally, our Navy lab in Egypt was the first to detect,
diagnose, and confirm highly pathogenic avian influence, H5N1,
in poultry in Afghanistan, Djibouti, Egypt, Iraq, Jordan, and
Kazakhstan.
In conclusion, the Institute of Medicine, in a review of
DOD-GEIS, described it as ``a critical and unique resource of
the United States in the context of global affairs.'' It is the
only U.S. entity that is devoted to infectious diseases
globally and that has broad-based laboratory capacities in
overseas settings.
Again, Chairman Akaka, Senator Coburn, Members of the
Subcommittee, thank you for this opportunity to present to you
today. Thank you particularly for taking this issue of emerging
infectious diseases so seriously.
I would be happy to answer any questions which you might
have at this time. Thank you.
Senator Akaka. Thank you very much, Colonel. Now we will
hear from Dr. Hill.

TESTIMONY OF KENT R. HILL, PH.D.,\1\ ASSISTANT ADMINISTRATOR
FOR GLOBAL HEALTH, U.S. AGENCY FOR INTERNATIONAL DEVELOPMENT

Mr. Hill. Senator Akaka, Senator Coburn, thank you so much
for convening this important hearing and inviting us to
participate, and it is a privilege to be here with my
colleagues from the other agencies with whom we work so closely
on many of these issues.
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\1\ The prepared statement of Mr. Hill appears in the Appendix on
page 238.
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My comments will focus on the work and vision of USAID, and
I would first like to note that our programs strengthen
surveillance systems by building developing country capacity to
detect newly emerging diseases. Second, our programs focus on
fully implementing both arms of the surveillance loop, that is,
early detection and rapid and effective response. Third,
recognizing the increased threat of diseases of animal origin,
our programs are fostering critical links between human and
veterinary public health. And, finally, interagency
collaboration is absolutely vital to our work and the work of
the USG to deal with these issues.
Diseases are not only significant public health threats, as
has been noted; they jeopardize international commerce,
development, and security. The estimates of the cost of SARS to
the global economy is between $30 and $100 billion. As has been
mentioned, the potential impact of an influenza pandemic
similar to that of 1918 could take the lives of 50 to 100
million people and devastate the global economy for years.
Such outbreaks are capable of destabilizing governments.
They increase the threat of international terrorism. In short,
anything we do abroad to affect this affects the national
security of this country.
USAID is in a critical position to help countries develop
these capacities and has taken on this challenge through
several of our programs targeting health system surveillance
capacity. The GAO report released today captures some of the
central efforts, such as our support for Field Epidemiology
Training Programs and WHO's Integrated Disease Surveillance and
Response (IDSR).
But in addition, I would like to mention that important
contributions are also being made by our disease-specific
programs. For example, since the mid-1980s, about $290 million
has been expended by USAID on polio surveillance in
approximately 40 countries, and as mentioned here already, some
of those labs work on other diseases besides polio. They have
impact elsewhere. One hundred and forty-eight national and
regional polio laboratories and hundreds of medical
surveillance officers have been trained.
But we also do work in tuberculosis and in HIV/AIDS and
malaria. Although these are disease-specific initiatives,
anytime you improve surveillance for specific diseases, you
improve the capacity to detect and respond to other diseases.
We have programmed $345 million to limit the spread of avian
influenza and to prepare for a possible pandemic, and this is
very important.
USAID and HHS and CDC are working together to support the
African Field Epidemiology Network. USAID and CDC are also
jointly developing a Field Epidemiology and Laboratory training
Program in Nigeria that will be the first in Africa to
integrate veterinary, laboratory, and field epidemiology
training. We work with the military, obviously, on NAMRU in a
variety of places. In fact, it is an excellent example of
interagency coordination, with the surveillance work
represented by the people before you today.
We work with important NGOs, such as the Wildlife
Conservation Society, through whom we have helped to establish
the Wild Bird Global Avian Influenza Network for Surveillance,
which is also called GAINS and is tracking influenza in wild
birds worldwide.
One of the most important lessons in human health of the
last 30 years is the fact that the human population is facing
an increasing risk from infectious diseases of animal origin.
Of all the pathogens that infect humans, about two-thirds
originated in animals--a sure sign that this has to be a focus
of our work.
Several recent outbreaks of zoonotic diseases demonstrate
that our investments really make sense. It was mentioned
already this afternoon that in Eastern Africa, specifically,
Tanzania, the response to a Rift Valley Fever outbreak this
year could not have happened apart from work that was done on
other topics, such as on avian influenza, which brought the
Ministry of Health together with other ministries--the Ministry
of Agriculture--in a way that they had not coordinated before.
It helped them to early diagnose and respond to the outbreak.
Finally, let me just note that in the future what we need
to do more of is study how we can scale up and more effectively
work together. We have commissioned the Institute of Medicine
at the National Academy of Sciences to convene an expert
consensus committee to consider the challenge of achieving
sustainable global capacity for surveillance and response to
emerging zoonotic diseases. A full report will be released in
2008, and I anticipate the finding will guide programming for
zoonotic diseases and enable us to be better prepared to make a
difference in the future.
Thank you very much, Mr. Chairman.
Senator Akaka. Thank you very much, Dr. Hill, for your
testimony.
Dr. Arthur, despite our efforts to control emerging threats
at the source, I understand that vaccine production can lead to
the creation of even more dangerous forms of these diseases.
China has an active vaccine research program for bird flu. They
also vaccinated their chickens.
Is there any indication that China's vaccination research
and vaccination of poultry contributes to continued mutations
of the bird flu virus?
Mr. Arthur. Thank you for your question, Mr. Chairman. The
use of animal vaccines is a little bit out of my scope of
expertise. I would consult with some of the many veterinarians
and the influenza specialists that we have in Atlanta and be
glad to provide that additional information for the record.
Senator Akaka. Well, thank you for that, Dr. Arthur.
The global disease surveillance and capacity-building
programs we are discussing today have been around for several
years. I am concerned that you are just beginning to evaluate
the impact of these surveillance programs. Why has this taken
so long? Dr. Hill.
Mr. Hill. Some of the programs that the GAO report noted
are new and have not yet been evaluated. Some of the other
programs, however, are much older, the polio programs, and our
work in other diseases, which have been operating long enough
that we have been able to do empirical studies to see if we
have had an impact.
For example, the evidence on the number of polio cases is
pretty startling. There were hundreds of thousands of cases in
the late 1980s, compared to less than two thousand in 2006. So
we know that the surveillance and the response to polio is
working.
Even influenza is an interesting case. It is also very new.
But we can tell that in places like Vietnam and other places in
the region that what we are doing is making a difference. But
we acknowledge that the fuller-scale evaluation is simply going
to take a little time.
The United States is very disciplined about its reporting
to Congress. We need to be able to promote results to make a
difference.
Senator Coburn has been a fierce fighter for being able to
show results in malaria. If you compare what we were doing a
few years ago on malaria prevention and surveillance with now,
the results are very encouraging. So when we put our minds to
it, we can do a good job.
Senator Akaka. Dr. Arthur.
Mr. Arthur. You are correct, some of the programs have been
in existence for several years. The GDD Program attempts to
bring these together so that the sum of the program itself is
more than the individual parts, and to develop a long-term
strategy to enhance the capabilities of all the programs.
Also, by having the GDD Program and these three programs
already mentioned as a part of those, it increases our
accountability, and we are able to develop monitoring and
evaluation systems to assess the progress of these programs. As
was mentioned by Mr. Gootnick, the evaluation was done for
2006. We now have that baseline. We will be starting our
evaluation of 2007 activities in December, and we will be glad
to share the findings of those with you early in 2008.
Senator Akaka. Thank you.
Colonel Erickson, what has DOD done to evaluate the impact
of GEIS for host countries?
Colonel Erickson. Mr. Chairman, we have learned a lot from
our colleagues, especially some of those that are at the table,
as to the proper ways to evaluate surveillance systems. In
fact, there is one particular reference which we hold to which
was published in 1988 and then republished in 2001, which
actually sets forth the standards for evaluating a surveillance
system, and I can get that for you. But it has some very
practical advice in it. Is the system actually doing what it is
called to do? Are the expectations being met? Is it
sufficiently sensitive? Is it timely to be able to report back,
etc.? Is it well accepted? In the case of our work, well
acceptance would not be just the military but the host country,
the community, the location at which the surveillance is going
on.
In practice, the way we evaluate our programs, we have
regular reporting requirements from our GEIS partners, which is
something that we look at very closely, monthly reporting,
quarterly, and annual reporting. In addition, we make field
sites. I can tell you that in my first year as the Director of
GEIS, I visited all five overseas labs to conduct personally
that very type of investigation and inspection.
In addition, we have outside external reviews which go on.
In 2001, the Institute of Medicine published a book which you
may be familiar with, which evaluated all of GEIS, and as Mr.
Gootnick in his opening comments made mention to, the Institute
of Medicine has just finished a new evaluation of our influenza
surveillance programs. The pre-publication meeting for that was
just this last week, and we are expecting that to hit
publication in the next month, and I would be more than happy
to make sure that you get copies of that.
Senator Akaka. Thank you very much. At this time I would
like to call on Senator Coburn for his questions.
Senator Coburn. Thank you, Mr. Chairman.
I have read the GAO report. How often do you all drill
together--in other words, create a scenario that is not true
but respond to it in a coordinated fashion? Anybody want to
answer that?
Mr. Hill. I would mention that we are in the process of
putting together a tabletop simulation--and tomorrow, in fact,
I have a meeting with the group that is designing the
simulation. We will be working with the same folks who put
together for CDC, in Atlanta, a series of tabletop exercises on
avian influenza. We are going to do it within the next few
weeks here in Washington at the Assistant Secretary of State
and Assistant Administrator of USAID level. And we are putting
the final touches on that to work specifically on the avian
influenza. That is the most recent one I know of related to
this sort of activity.
Senator Coburn. And that will include all the rest of the
gentlemen at this table?
Mr. Hill. Yes, I think it will include all the agencies and
departments represented at the table.
Senator Coburn. OK. But we have not done that yet, right?
We have not said, ``here is a scenario, a false scenario, we
have generated some type of practice, so that if we see another
SARS or we see H5N1, do we know what we are doing and that it
is going to coordinate?''
Mr. Hill. We actually are modeling this in part on what CDC
has done several times already related to avian influenza, but
we are bringing it to Washington to work on the agencies that
are here.
Senator Coburn. OK. Do your IT systems communicate between
the different agencies--DHS, CDC, USAID, Department of Army? Do
you all have effective communication of your data links?
Mr. Smith. Sir, I find that an excellent question. I really
do. And I am going to be the first one up to the plate here to
say that, looking toward the future, I think that they
absolutely must. I find that Health and Human Services and the
Centers for Disease Control are taking the lead with the Office
of National Coordination and with the National Center for
Public Health Informatics, and setting a standard for a Federal
health architecture, setting a standard for the National Health
Information Exchange. We, at the Department of Homeland
Security, are involved in those activities and making sure and
certain that our IT systems that are involved, particularly
with biosurveillance, are compliant and will be able to
exchange information.
Senator Coburn. So, in other words, the answer to the
question is the biosurveillance data now are not compatible
from agency to agency.
Mr. Smith. Sir, I would not say that is true across the
board.
Senator Coburn. Well, but it is not totally compatible so
that the data you have and the analysis you have are available
to all the other groups that we are depending on for
biosurveillance.
Mr. Smith. I would have to say that across the board that
is correct, sir.
Senator Coburn. DHS is really at the center of this. Do you
all have a program that coordinates right now the integration
of data? Or is that what you were speaking to, you are
developing that and planning on having that, but you do not
have a coordinated, integrated program right now so that
everything could feed to DHS?
Mr. Smith. Sir, that is correct. That is what we are in the
process of developing now.
Mr. Hill. But, Senator, I should probably mention that the
agreement between CDC, HHS, USAID, and others has been to
facilitate WHO as the center for collecting much of this
information with respect to our international programs. And so
there has been a lot of work that has been put into making sure
that systems are in place, that we will flow through WHO a lot
of this information. So there is an attempt----
Senator Coburn. OK. Well, that is great. So we do have one
place. Do you all have access to all the data that flow into
WHO?
Mr. Hill. As far as I know, the information we share, the
whole point of that is information----
Senator Coburn. To get a coordinated response.
Mr. Hill. Right.
Senator Coburn. But does every other group on this panel
have access to that information, that we have shared in total?
Mr. Hill. The international health regulations, which WHO
has been working on and we are trying to get as many countries
involved in as possible, the whole requirement of that is that
people get the information or countries get the information to
WHO. The expectation or the requirement is that WHO get it back
to the rest of the globe in the appropriate way so that the
information is useful. Whether all the countries are----
Senator Coburn. Well, I am not really concerned about the
rest of the countries. I am concerned about what we are doing
and what we are collecting and what we are trying to create in
terms of surveillance capability outside of this country. Do we
have the IT capability to know what that is if we put it in
and--I know we are building that at DHS, but what we give up
and goes to a centralized collection point, does everybody have
access to that now?
For example, if your computers cannot talk to DHS but you
both can talk to WHO, can Dr. Smith get the information that
you have computed to WHO and bring it back to DHS?
Mr. Hill. I would need to get an authoritative answer on
that, but I believe the answer would be yes. I think anything
that we could communicate to WHO we would certainly be able to
communicate to each other.
Senator Coburn. Should we have had WHO representatives here
today, especially our delegates to WHO? And could we maybe ask
them some questions on the basis of what we are finding here
today and get their input, because that would have been
probably helpful to see what their input is since they know
what that is.
Colonel Erickson. Senator Coburn.
Senator Coburn. Yes, sir.
Colonel Erickson. If I could just weigh in, in terms of
more perhaps pedestrian IMIT capabilities, we use computers and
e-mail and push data, use VTCs, telephones, etc. DOD has a very
close working relationship with CDC to the point where we are
sharing reports, we are sharing isolates. We, in fact, use them
as sort of our Supreme Court where we send those isolates for
further confirmation and for selection of isolates for, for
instance, vaccine development.
Within the WHO, as I mentioned in my earlier comment, we
have a military medical officer who is assigned there full time
who provides that link to much of that information. In
addition, we are a member of the Global Outbreak Alert Response
Network (GOARN), which also provides a forum for getting that
information out to the different agencies, many of those
represented here.
And so there are good systems in place. We can do better,
certainly, that you are alluding to, but I would not want to
leave you with the impression that we are not----
Senator Coburn. I know you have the capability to
communicate, but the problem we have across the government is
we have stovepiped IT programs that very much limit the
capability of accessing people who need to know and can utilize
the information that is easy.
Colonel Erickson. Sure.
Senator Coburn. And that is one of the goals. We spend $65
billion a year in this country on new IT programs, of which $20
billion gets wasted every year. And so this is an important
area. If we are going to allow you to be more efficient and
functioning better, what we have to do is make sure that
everybody's goal is to eventually get to where we can talk to
one another through our computers, analyzing data, so we do not
have to buy new programs so that one computer can talk to
another computer. That was the purpose for the question.
The GAO identified several weaknesses within DHS. One was
there has not been consistent leadership at DHS for this
program, and that is probably a legitimate criticism, and that
is no reflection on you whatsoever.
Does DHS have a plan with metrics and milestones for
addressing the weaknesses that GAO identified in their report?
Mr. Smith. Yes, sir, we do.
Senator Coburn. And is that plan available to this
Subcommittee?
Mr. Smith. Certainly it will be.
Senator Coburn. OK. Well, I would very much appreciate a
copy of that.
I just have one other comment, Mr. Chairman, and then I
have to go to the floor to offer some of my dreaded earmark
amendments so that we can get money to run the government
instead of run the politicians.
I think back to the SARS outbreak. We did not get a handle
on that until we stopped commerce. Under the threat of the stop
of commerce did we get compliance. And our goal has to be to
get where we do not have to go to that level. And I know that
is what the goal is in terms of trying to build surveillance
teams and everything else.
Would any of you care to comment on how we could have done
that better and not wasted the time where we finally had WHO
issue a travel ban to get compliance out of a foreign country
who at first was denying that there was an epidemic--in other
words, what it did is more people died because of the denial
that there was a problem. What can we do as America--we cannot
imfringe on the sovereignty of other countries, but can we work
better and can we bring to bear forces sooner so that we get
the proper reaction? And I am talking all types of leverage--
suspension of aid, all these other things--to get people, when
they have the resources and know how to do it, to actually
report it. Any comments? Yes, sir, Dr. Arthur.
Mr. Arthur. That is exactly the intent of the International
Health Regulations, which came into force for the United States
in July of this year. There had been a 10-year process to
revise those regulations and move away from a list of three
diseases to a concept of identifying a particular health threat
so that it would account for new entities such as SARS or the
next unknown disease that may occur.
Senator Coburn. And in your position at CDC, do you feel
pretty comfortable that we are going to see--because of the new
regulations, we are going to see much greater coordination
because of those?
Mr. Arthur. I think the international political pressure
will increase dramatically since under the new International
Health Regulations, WHO could have gone to China in December
when I was in Geneva and first knew about these reports several
months before it became publicly known--this was in 2002--go to
China under the new International Health Regulations and say,
look, another member state has reported that they see this
event, you are required under the International Health
Regulations to respond in 24 hours and provide that
information. If China then does not do so, then WHO would use
other political pressures, other countries and so forth, which
now have signed--all 193 countries in WHO have agreed to accept
the International Health Regulations--then would be in a
position to leverage tremendous international pressure on China
to do the right thing. China, as a signatory to the IHR, they
would be required to respond to that.
Senator Coburn. And so what are the actual teeth of that
response? If they fail to respond, what are the teeth? They
have signed an agreement. They are not complying with the
agreement.
Mr. Arthur. The IHR unfortunately does not have any
punitive or penalty assigned to it, so WHO is not in a
position----
Senator Coburn. So, therefore, it is going to require
courage on the part of the people leading WHO to do a travel
ban early, to threaten those things.
Mr. Arthur. Right. But the information also will be
disseminated internationally to all the other countries saying
that we have this situation in China, we have asked for
information, we do not know what is going on. The WHO Director
General, if she determines the event to be a public health
emergency of international concern, has already a pre-rostered
committee that would advise her on the recommended measures
that she needs to take, and it could include travel bans, it
could include travel restrictions, whatever. But this would be
the international community that would be dealing with the
problem.
Senator Coburn. But you would agree the thing that got
action was the travel ban on that? When that was issued, they
started cooperating. Is that correct? I mean full-fledged
cooperation. When there was a travel ban issued by the WHO,
what happened? All of a sudden we had admission there is a
problem and help. Right?
Mr. Arthur. They were very closely timed with each other,
yes.
Senator Coburn. Yes, all right.
Thank you, Mr. Chairman. Thanks for holding this hearing.
Senator Akaka. Senator Coburn, just to answer your question
about WHO, it is not that we have not thought of them, but we
received the message that, for whatever reason, they would not
testify before Congress.
Senator Coburn. Actually, I was wanting our members that
come from our country to WHO to testify, not WHO. In other
words, our delegates, because they represent us there, and I am
certain that we can ask them questions--I would hope. It is not
surprising that a lot of international agencies are not very
transparent and responsive to some of the demands of Congress,
even though we contribute about 25 percent of all their
funding.
Thank you.
Senator Akaka. Thank you very much, Senator Coburn.
My question is to Dr. Hill, Dr. Erickson, and Dr. Arthur.
The programs you have summarized in your statements describe
surveillance of known diseases. But what about diseases we have
not seen before? It took many weeks for human and animal health
experts to figure out that it was West Nile virus, a disease
not previously seen in the Western hemisphere, that was killing
the birds and people in 1999 in New York City.
Can you give us assurance that your surveillance systems
can help to identify and monitor new or emerging diseases that
have not been seen before in this country? Dr. Hill.
Mr. Hill. I think the first thing I would say is it would
probably be a question almost like a puzzle--the process of
elimination. If you have the right labs set up globally and you
know you have got a problem, there is an outbreak of something
that is killing people with high fevers, etc., the most obvious
thing, of course, to do would be to test for the known likely
possibilities.
If all those tests come up negative, in the sense it is
clearly not what it is, it is obviously something else. Will
that tell you what it is necessarily? No. But it will at least
tell you that you have got a problem that you better address
pretty quickly.
As I understand it on HIV, one of the big problems was we
did not pick up years, maybe even decades, before that
something was going on, that had we known or had our
surveillance systems been more sensitive, we might have
responded much quicker and perhaps have stemmed the tide. But
we did not even realize or pick it up.
But you cannot do anything if you do not have the labs in
place to test for the known possible problems. If you have
that, then you have at least a chance to know that you are
dealing with something new.
Senator Akaka. Dr. Erickson.
Colonel Erickson. Mr. Chairman, your question is an
excellent one, and it is one that we frequently will discuss
among ourselves. We have different aspects to our surveillance
efforts. The syndromic surveillance, which we do in a number of
areas, is not dependent upon a lab test. It is not dependent
upon having actual diagnostic tests to know what something is.
We can use case definitions, syndrome constellation of symptoms
to determine that there is something going on, there is
something new. It might look like diarrhea, it might look like
a respiratory disease, it may have a high fever, etc. And that
is the first indication of what we can do.
If I can add to Dr. Hill's comments, the response can start
at that point. For instance, in the case of SARS, the response
was started in advance of there being diagnostic capability to
realize that it was a coronavirus. And so my encouragement is
that we continue to focus on an approach which builds broad-
based laboratory capability, which enables us to have a
sufficient number of public health practitioners,
epidemiologists, etc., build this human capacity so that we can
respond with the bread and butter, tried and true public health
responses that will be somewhat generic for many of these new
types of threats, realizing that we need the lab capability, we
will need to finally know through molecular microscopy, through
genetic sequencing, etc., that it is something new, that we are
now going to call it virus X. But the response can start before
that, and so I think building the broad public health
infrastructure at this point is key, because we will not
necessarily know--I cannot tell you, sir, that we are
absolutely ready to be able to diagnose something that is new
because we will not necessarily know. We will have to be
responding before we know.
Senator Akaka. Thank you. Dr. Arthur.
Mr. Arthur. I would like to add one additional aspect. I
think one of the key elements and one of the things that we are
very sensitive to and invest a considerable amount of effort at
CDC, particularly in the Global Disease Detection Operations
Center, is to look for those events which are unexplained,
unexpected, unusual, and to use--instead of conventional
surveillance systems with reporting systems, particularly in
international settings where those types of infrastructure do
not--that infrastructure both for reporting and laboratory
diagnosis do not exist, using media reporting and mining of
news reports. And you will hear later this afternoon about a
project, Project Argus, from Dr. Wilson at Georgetown
University.
These reports, while they are very non-specific and often
require verification, are incredibly important as a first alert
for something unusual happening, something that needs further
investigation, and then it can be followed up with the
appropriate laboratory studies, etc.
But it turns out that in resource-poor countries in many
parts of the world, the press report or the reporter is one of
our best surveillance officers. They are highly motivated to
provide this information, and it gets disseminated very
broadly, and we focus on picking up those early signals.
Senator Akaka. Thank you. As you know, because the Chinese
Government was not forthcoming in reporting cases of SARS and
avian influenza, these diseases spread more widely and more
quickly.
Are you considering incentives to encourage countries to
report these diseases before they become pandemics? Mr.
Gootnick.
Mr. Gootnick. Well, I would refer back to the earlier
conversation on the International Health Regulations, which,
amongst other things, is a politically binding document,
creates an international norm, and is intended to facilitate an
international response. It is important to recognize that the
International Health Regulations, while they were adopted by
the World Health Assembly in 2005, have really just now entered
into force in 2007, and there is a phase-in period that really
takes us out to 2012 before there is really a full
implementation and binding set of agreements and expectations
that the ability to intervene on the part of the international
community is implemented.
And then, even at that, the resources for countries who are
motivated to take the steps dictated by the International
Health Regulations are, at the beginning at least, the
obligation of those sovereign nations.
Senator Akaka. Thank you. Dr. Arthur.
Mr. Arthur. I think one of the incentives that we can
provide to countries is building the capacity for them to be
transparent and feel comfortable in doing so about an event. If
something bad is happening in their country, frequently
countries do not report because it is associated with some
economic impact--loss of trade, tourism, whatever. By providing
countries with risk communication skills so that they feel
comfortable talking to their populace about a particular
problem, knowing how to say, yes, we have a problem in the
country, knowing that we have someone standing beside us,
whether it be WHO or another country that is providing
assistance, it is not good news, but we are doing something
about it and we are attempting to do something about, having
resources available to support epidemiologic investigations and
laboratory investigations and appropriate interventions from
the international partners also gives the country some
confidence then that they are more willing to go forward with
the information because they are actively doing something in
the eyes of the global community to contain the event; and,
more importantly, they are helping their own populace and their
country.
Senator Akaka. Dr. Smith.
Mr. Smith. Yes, sir. Certainly, we are considering
incentives that we might offer, and the Department of Homeland
Security might have a little bit different take than the other
agencies represented here at the table. The exchange of
information or information sharing that might not otherwise
happen from the integration of biosurveillance information,
perhaps not at the WHO level but at a different collection
level, the sharing of best practices, and some of these will
branch out into non-traditional means. Certainly, as Dr. Arthur
has mentioned, there are not necessarily health care workers or
the public health infrastructure to report up, examination of
non-traditional sources of information. DHS is involved in the
trilateral talks and negotiations for counterterrorism and
presenting the integration of law enforcement and public health
and agriculture and how that exchange of information can
actually facilitate reporting and awareness in rural areas or
outside of metropolitan areas.
Senator Akaka. Colonel Erickson.
Colonel Erickson. Mr. Chairman, I just would want to say
that I wholly agree with my colleagues here in other comments
already made. My sense is this issue of getting to transparency
involves a cultural change, and though we can look for
incentives in the near term, I think we are looking at a
generational effect. And that is the reason why I think many of
our programs have training components in them, where, in fact,
we are training the next generations of laboratorians,
epidemiologists, public health officials to step into a culture
where reporting will not be punished, where bad news will not
be received and bad things will happen to you because you are
the one that is reporting.
But that is, in my mind, a cultural change that we need to
effect through these many efforts that you are hearing about
today.
Senator Akaka. Thank you. Dr. Hill.
Mr. Hill. Just to summarize, I think there are four ways to
incentivize the kind of reporting you want. I will start with
the most negative first. Most countries want to be a respected
member of the international community, but I think that should
not be our first line of defense. Negative publicity does have
an impact sometimes.
Also, second, if we make it very clear that when countries
do the right thing they will be welcomed into the international
community, that is a big deal, frankly. And if you think what
happened last year at the major Beijing conference where China
was the international host for a big international conference
to raise funds for avian influenza, at which was discussed how
do you avoid the kind of thing that happened with SARS, I think
it was very significant that China was willing to take the lead
in hosting such a conference. So they clearly want to be a part
of something that works better than what happened during SARS.
And then, third, it has been mentioned, but I think it
needs to be mentioned again: the promise that if you share
information you are going to receive information is a powerful
incentive to be up front.
And, finally, if there is some sense that if you report a
problem you are going to be helped, the international community
will help you deal with it, is significant.
And one last point that relates to the last question.
Sometimes we get in the habit of thinking everything has a
technical silver bullet, and I was the one that talked about
the importance of labs, and I believe in the importance of
labs. But even if the lab is present, the best labs in the
world may not be able to identify a new problem. We still do
not have a solution to HIV. We do not have an HIV vaccine. But
we know how to prevent it. We know how to contain it.
If on the front lines globally out in the rural areas we do
a much better job of communication so that people know what
they should look for, what they should report immediately, and
those people take the right action, you can quarantine
immediately. You can quarantine several square kilometers and
avoid a problem. That does not require a technological bullet
solution.
So there is an awful lot that can be done short of the
solutions we hope are down the road that will control a lot of
this much better than in the past.
Senator Akaka. Well, I want to thank you very much. That is
a good summary, I think, of this panel. I want to thank all of
you for your valuable testimony. I look forward to working with
each of you to ensure that we are aware of potential emerging
diseases and the threats that could impact the United States.
And I would ask that our second panel of witnesses then come
forward, but we may have questions from other Members of this
Subcommittee that we will submit to you for your responses.
So thank you very much for your testimonies and your
responses.
We welcome the second panel to our Subcommittee hearing:
Dr. Nathan Flesness, Executive Director, International Species
Information System; Dr. Daniel Janies, Assistant Professor,
Department of Biomedical Informatics, Ohio State University
Medical Center; and Dr. James Wilson, Director, Division of
Integrated Biodefense, Imaging Science and Information Systems
Center, Georgetown University.
Again, it is the custom of this Subcommittee to swear in
all witnesses, and so I will ask you to rise and raise your
right hand. Do you solemnly swear that the testimony you are
about to give this Subcommittee is the truth, the whole truth,
and nothing but the truth, so help you, God?
Mr. Flesness. I do.
Dr. Janies. I do.
Dr. Wilson. I do.
Senator Akaka. Thank you. Let it be noted in the record
that the witnesses answered in the affirmative.
Mr. Flesness, will you please proceed with your statement?

TESTIMONY OF NATHAN R. FLESNESS,\1\ EXECUTIVE DIRECTOR,
INTERNATIONAL SPECIES INFORMATION SYSTEM (ISIS)

Mr. Flesness. Thank you, Chairman Akaka, and thank you for
this opportunity to testify on the infectious disease
surveillance role our unprecedented new Zoological Information
Management System (ZIMS), can play for the United States and
other countries. It is an honor to be asked to appear and
valuable to learn from other members of both panels.
---------------------------------------------------------------------------
\1\ The prepared statement of Mr. Flesness with an attachment
appears in the Appendix on page 246.
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The International Species Information System (ISIS), is a
34-year-old, U.S.-based nonprofit of international scope. ISIS
has spent three decades building a worldwide network of 700
zoos and aquariums which pool detailed animal data on 2 million
specimens of 10,000 species. Maps and lists of our members are
attached to my written testimony.
We currently cover facilities in 73 countries on all six
occupied continents. This includes 263 ISIS member zoos and
aquariums in 47 States of the U.S. ISIS is by far the world's
largest membership organization of zoos and aquariums and
continues to grow.
For example, the Indian Government has just announced they
will sponsor 59 Indian zoos to join ISIS next year.
Honolulu Zoo Director Ken Redman sends his regards to you,
Chairman Akaka, and would welcome the opportunity to show you
how his zoo will use our new ZIMS system to connect to other
zoos worldwide.
After several years of fundraising and software
development, we are now testing this profound transformation in
our capabilities. Our new Web-based, real-time software, ZIMS,
will replace our older systems, be online sharing information
among our members, and keeping watch for zoonotic infectious
diseases.
Avian flu is, of course, the current concern, and ZIMS will
include powerful worldwide monitoring for the different strains
of avian influenza. But ZIMS will be equally powerful for
detecting the next disease threat and the ones that will come
after that. This is a long-term permanent effort to develop
both situational awareness and an early-warning system for all
zoonotic diseases.
In fact, if you were going to imagine an ideal zoonotic
disease biosurveillance system which could help stand watch in
countries around the world, in my mind it would monitor
thousands of species of animals, daily or hourly, to be sure to
include vulnerable hosts for any threatening disease. It would
use already trained and paid veterinary wildlife professionals
for this monitoring. It would monitor animals in hundreds of
urban centers worldwide where, in fact, most humans are. It
would have already established broad international data-sharing
cooperation and a culture of trust. It would have all data on
the Web in real time. It would have enormous detail, such as
vaccination history of each specimen stored serum samples, and
so on. And it would be primarily privately supported.
Of course, the system I am talking about is the one we are
finishing called ZIMS. After 3 years of design and development,
it is now in testing and will roll out worldwide starting July
2008.
You have already noted, Chairman, that the zoo community
has demonstrated its considerable power to spot new and
emerging diseases with the story about West Nile virus. With
ZIMS, they will be able to do so even more rapidly in real
time.
When the next human pandemic outbreak happens, it will come
from and affect animals. It may be a disease we have already
worried about, or it may be one we have never noticed before.
ZIMS will give countries around the world valuable additional
power to spot the next threat early, whether it is an old or a
new disease.
To make this real, consider the following hypothetical
scenario. On a Thursday morning, an animal keeper named Susie
Chi, working at a Southeast Asian zoo, makes her morning rounds
and observes with concern that the leopards in two different
exhibits look ill. She radios the veterinarian, Dr. Paulo, and
stops by her desk to enter these observations into ZIMS.
Receiving the call, Dr. Paulo checks ZIMS for the best
anesthesia drugs and doses and then does a hands-on physical.
He draws blood samples and orders the animals moved to the
hospital. His assistant enters the data into ZIMS while Dr.
Paulo does some preliminary blood work. He sees anomalies he
does not recognize and sends the sample by courier to the local
university lab.
Dr. Paulo then searches in ZIMS to see what problems other
ISIS members have with leopards recently. He notes one very
recent and troubling case of a similar problem of unknown cause
reported a few days earlier. Over the next few hours, Dr. Paulo
sees in ZIMS that a nearby zoo is now reporting similarly ill
leopards and, more alarmingly, problems with other big cats.
By the close of this first day, the ISIS-ZIMS
epidemiological scanning program automatically detects an
unusual pattern of animals becoming ill within a short time in
the same geographical area. An ISIS staff veterinary
epidemiologist is automatically alerted. She calls Dr. Paulo
and confirms there are grounds for concern and learns the
disturbing fact that both of the animal keepers involved have
just called in sick. She advises Dr. Paulo on local useful
governmental, CDC, OIE, and WHO contacts and triggers an alert
to ISIS partner agencies. Less than 24 hours have passed since
that first animal was noted sick on the other side of the
world.
To develop ZIMS, ISIS had meetings with the World
Organization for Animal Health, the new European Union CDC in
Stockholm, CDC Atlanta, Homeland Security, and other agencies.
They have helped us see just how unique and powerful ZIMS will
be. No one has ever built an internationally adopted,
computerized, lifetime medical records system for humans or
animals before. To our surprise (to be honest), ISIS-ZIMS seems
to be the first.
We have built ZIMS mostly with private funds, primarily
from our member institutions. Currently, we are working with
NBIC officials to design a framework for sharing ZIMS data and
are cooperating on standards and compatibility. We look forward
to NBIC's support for ZIMS training and rapid rollout to 25
major U.S. metro areas in key sites abroad. We are also hoping
for NBIC's support to hire staff to watch for and interpret
data patterns, and we hope to borrow the disease detection
algorithms.
While ISIS currently has robust global coverage, we are
also seeking an additional $2 million a year to cover far more
institutions and cities in Latin America, Asia, and Africa, and
be online standing watch in those regions.
A couple of points to leave you with in closing. As you
have already noted, it is experts in our network who are
finding diseases such as West Nile virus early. It takes
decades to build the broad cooperation we already have. ZIMS is
mostly privately funded and represents a $25 million
investment. ZIMS offers the Federal Government an enormous
opportunity to leverage private sector capability with a modest
Federal investment and add an additional, effective, global
zoonotic disease surveillance system to our pandemic defenses
quickly. Thank you very much.
Senator Akaka. Thank you very much, Mr. Flesness. Now we
will hear from Dr. Janies.

TESTIMONY OF DANIEL A. JANIES, PH.D., ASSISTANT PROFESSOR,
DEPARTMENT OF BIOMEDICAL INFORMATICS, OHIO STATE UNIVERSITY
MEDICAL CENTER

Dr. Janies. Thank you, Chairman Akaka. I am an Assistant
Professor in the Department of Biomedical Informatics at the
Ohio State University. My current research concerns the global
spread of emergent infectious diseases. This work involves the
use of large-scale computations on genetic and geographic data
derived from viruses and their hosts, both animal and human. I
received a Bachelor of Sciences degree in biology from the
University of Michigan and a Ph.D. in zoology from the
University of Florida. I worked as a postdoctoral fellow and a
principal investigator at the American Museum of Natural
History in New York City where, with funding from NASA and the
city, we built one of the largest computers used in biological
research.
At Ohio State and the museum, we are using public databases
of genetic sequences from viruses isolated from human and
animal hosts. Just as deciphering an enemy code can provide
warning of an attack, we are decoding the genetic sequences of
emergent viruses in order to protect our citizens and food
supplies.
We are interested in genetic codes such as mutations that
confer drug resistance among viruses and permit viruses that
were once restricted to animal hosts to infect humans. With
funding from DARPA, we have created a computational system to
rapidly compare genetic sequences and return a global map
depicting the spread of viruses carrying key mutations over
hosts, time, and geography.
As demonstrated by the success in stopping SARS, the rapid
collection and dissemination of sequence data throughout the
research community are key components in the fight in emergent
diseases. Decision makers and the research community must work
together to translate raw data into actionable knowledge. We
have developed the information technology to track the stepwise
movement of diverse strains of viruses over different countries
and among various hosts. We monitor the spread of dangerous
strains of viruses that are resistant to drugs or are able to
infect human and animal populations. Regional threats are
forecast based on the distribution of these dangerous strains
with respect to population centers, farms, and areas of
military deployment.
As we scale our computational infrastructure and staff, we
are able to rapidly add new data on a variety of agents of
infectious disease and generate knowledge on which preemptive
measures are important. Our maps, as depicted in this graphic
here, are useful for understanding the complex mixture of
processes that spread disease in various regions. For example,
in Indonesia it is clear that chickens are responsible for
spreading avian influenza--in this map, chicken-hosted viruses
are depicted in blue lines--whereas in other areas, such as
Central China, migratory birds are important. In this graphic,
strains of avian influenza that are hosted by ducks and other
migratory birds are depicted in red lines.
However, illegal trade is also a concern. There was an
interesting case in 2004, where an eagle infected with avian
influenza was smuggled from Thailand to Belgium. While this
infected eagle was quickly confined and the virus did not
spread at that point, that case appears as a clear anomaly in
our map, betraying an instance where illegal trade allowed
avian influenza to make a huge geographic leap. I would like to
turn your attention to the large green line showing the strain
of avian influenza infecting the smuggled eagle is actually
related very closely to Thai strains, and the geographic reach
of that line is anomalous with respect to the other lines.
Anomalies such as this provide means to detect illegal trade
processes carrying avian influenza.
Furthermore, using methods we have developed, we can detect
and visualize gaps in the available data that represent
undersurveyed regions or underreporting. Even though we have
made tremendous analytical advances, a significant portion of
the data on avian influenza remains in private hands. Among the
reasons for the lack of data sharing include the career
aspirations of scientists who want first crack at the data and
the interests of nations to assure that their citizens will
have access to vaccines.
In light of the severity of the health and economic issues
surrounding influenza, we have tried to change the model for
data sharing via collaboration and co-authorship with
international colleagues who work in the field and are
providers of key viral strains for sequencing. These efforts
have been exemplified by the Influenza and Coronavirus Genome
Sequencing Projects, who are funded by the NIAID under a
mandate to share data within 45 days of collection.
I realize that data-sharing issues are complex and that a
balance of competition and collaboration is natural, both in
science and international relations. We will use the data
security concepts that have been developed to protect the
privacy of patients while allowing clinical research to move
forward in the context of data sharing on emergent diseases.
For example, cancer research is currently being accelerated
by a data-sharing and analysis initiative of the NCI called the
Biomedical Informatics Grid. We will apply the same underlying
software for analysis and mapping of infectious diseases.
Mr. Chairman, I am pleased to have had a chance to discuss
these issues with you today and I welcome questions.
Senator Akaka. Thank you very much, Dr. Janies. Dr. Wilson.

TESTIMONY OF JAMES M. WILSON V, M.D.,\1\ DIRECTOR, DIVISION OF
INTEGRATED BIODEFENSE, IMAGING SCIENCE AND INFORMATION SYSTEMS
(ISIS) CENTER, GEORGETOWN UNIVERSITY

Dr. Wilson. Good afternoon, Mr. Chairman. I appreciate the
opportunity to testify about Project Argus, the biosurveillance
priming system developed and implemented at Georgetown
University's ISIS Center. Argus is designed to detect and track
early indications and warnings of foreign biological events
that may represent threats to global health and national
security. Argus serves a ``tipping function'' designed to alert
its users to events that may require action, but it does not
determine whether or what types of actions should be taken.
---------------------------------------------------------------------------
\1\ The prepared statement of Dr. Wilson appears in the Appendix on
page 254.
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In the summer of 2004, the Intelligence Technology
Innovation Center (ITIC), and the Department of Homeland
Security funded our research and development of a foreign
biological event detection and tracking capability called
Argus. Argus is based on monitoring social disruption. Local
societies are highly sensitive to perceived emergence of
biological threats, and the resulting conditions and responses
are readily identifiable through a granular review of local
sources of information.
Argus specifically focuses on three types of indications
and warnings: Environmental conditions conducive to outbreak
triggering; reports of disease outbreaks in humans or animals;
and markers of social disruption such as school closings or
infrastructure overloads.
The system is built on advanced operational social
disruption and event evolution theory; unique disease event
staging and warning; a defined doctrine of biosurveillance;
real-time, high-performance Internet technologies; advanced
modeling and linguistics capabilities; visualization and
modeling capabilities; and disease propagation modeling.
Argus analysts focused on identifying trends in disease and
on social behaviors associated with such events and are
accessing over a million pieces of information daily worldwide.
They produce, on average, 200 reports per day. Using a disease
event warning system modeled after NOAA's National Weather
Service, we issue on average 15 advisories, 5 watches, and 2
warnings at any given time, with 2,200 individual case files of
socially disruptive biological events maintained and monitored
daily in over 170 countries involving 130 diseases affecting
animals or humans.
To facilitate operational validation, we initiated an
unofficial Biological Indication and Warning Analysis Community
(BIWAC), which reviews our reporting requirements quarterly to
ensure proper product alignment with the user. The BIWAC now
includes CDC's Global Disease Detection team, whom you have
heard from today; USDA's Centers for Epidemiology and Animal
Health; DHS' National Biosurveillance Integration Center; the
Armed Forces Medical Intelligence Center; other Intelligence
Community organizations; the Defense Threat Reduction Agency;
and the U.S. Strategic Command Center for Combating Weapons of
Mass Destruction.
To enhance this process, we activated a new Internet
portal, Project Wildfire, where Argus-derived warnings and
watches are posted to facilitate unclassified dialogue among
the BIWAC partners. Wildfire, although experimental, has
attracted a substantial amount of Federal use. The Argus
Watchboard has an audience from 100 organizations, including
State of Colorado officials and the DC Department of Health.
There is a significant degree of uncertainty surrounding
biological event indications until ground verification has been
obtained. Time is critical, and developing an approach to
integrated, federally facilitated ground verification is
important.
As examples, Argus has served as the lead tactical global
event detection team for H5N1 avian influenza; provided daily
situational awareness reports to tsunami-related humanitarian
responders; notified the U.S. Government of undiagnosed
vesicular disease in cattle in the United Kingdom, later
diagnosed as hoof-and-mouth disease; and reported indications
of the current Ebola epidemic in the Congo.
Eight months ago, the Argus team identified hundreds of
reports of an H3N2 influenza virus that has possibly drifted
away from the current vaccine strain and collaboratively worked
with CDC to track this important finding. The value of this
information was validated when the WHO and its partners
recommended a change in the Southern hemisphere influenza
vaccine to include an updated H3N2 strain.
Argus reached full operational capability in July 2007, but
there are challenges ahead. Funding for Argus is currently
secure only through July 2008. We hope that you will agree that
Argus should be maintained well beyond that date.
This global biosurveillance resource needs to be
operational within the United States. Because of our funding
source, we are prohibited from monitoring domestically. DHS
recently issued a sole-source request for a proposal to
initiate work on Project Hyperion, but it has not yet been
funded. That needs to happen.
There remains an important need for continued enhancements
of Argus. The methodology can be made sensitive to nuclear,
radiological, chemical, terrorist, and natural events. Also,
the current Argus network does not fully incorporate wildlife
disease outbreaks; therefore, we have approached the Wildlife
Conservation Society.
Finally, decisions need to be made about dissemination of
Argus-generated information.
Thank you again for this opportunity to testify. I stand
ready to answer any questions you may have.
Senator Akaka. Thank you very much, Dr. Wilson.
What steps do you think should be taken to better integrate
human and animal emerging disease surveillance? Mr. Flesness.
Mr. Flesness. Thank you, sir. I think, sir, that meetings
like this that happen informally behind this podium, where the
people with various parts of the solution could work together
and be encouraged to combine those efforts would be extremely
productive.
Senator Akaka. Thank you. Dr. Janies.
Dr. Janies. I concur with Mr. Flesness. I think the common
framework we have developed in using genetic data is actually
very important, because the viruses do not care if they are
infecting humans or animals, they are just DNA ORRNA hitching a
ride across different organisms. Thus a genetic approach
provides commonality. Similarly we are using an open-source
solution for sharing data. Much like HTML is interoperable on
all Web browsers, we are using KML, a language for sharing
geospatial data, which is interoperable throughout all
geospatial browsers such as used by Argus.
Senator Akaka. Dr. Wilson.
Dr. Wilson. Sir, I am in vigorous agreement with the prior
answers that have been given here. Networking is critical.
Collaboration is critical. We cannot function in a vacuum at
Argus. As powerful as this capability is, it is useless without
collaboration. And I hope that you will see, too, that even
with the panel here today, everyone has a unique competency, a
unique skill set that is being brought to the table. The world
of biosurveillance is beginning to speciate, if you will. There
are a lot of unique expertise and disciplines and competencies
evolving that all have to work together, a lot of different
parts to a well-tuned engine, so to speak.
So we have to work together and we have to drop any kind of
stovepiping mentality, in the interest of the mission.
Senator Akaka. Thank you, Dr. Wilson.
Mr. Flesness, how can ZIMS be useful to NBIC? And how do
you believe DHS can use ZIMS data to identify and dissipate the
emergence of new diseases that are transferred from animals to
humans?
Mr. Flesness. Thank you, Mr. Chairman. I believe that ISIS'
new ZIMS system can help NBIC by providing, as it were, an
extra layer of information focusing on incredibly intensively
watched animals located primarily in urban centers with a
little bit of diffusion because of the interests and projects
of the veterinarians that work with the zoo animals that are
often involved in wild animal projects outside the city. That
gives us sort of a fuzzy dot in 700 cities around the world,
and I think detecting both syndromics early on--because we have
a very rapid response system since it is real-time--and,
second, as the cases develop and there is more and hard
information available, and the fact that we have a culture of
sharing already established, we think we have quite a resource
and quite a unique international resource to help NBIC and
hopefully its equivalents in other countries around the world
make sense of and confirm patterns of data provided to them.
Senator Akaka. Thank you.
Dr. Wilson, you mentioned some of the governmental
consumers of data collected by Argus. It seems that the
information you collect and analyze would be valuable to a
broader spectrum of users, including those at the State and
local levels and the public health community.
Are there any plans to expand access to Argus information
and, in particular, the similar reports of your product and of
what you produce?
Dr. Wilson. Yes, sir. That is the key question, Mr.
Chairman. Our team believes that this technology is going to
change the way that we do business in biosurveillance, at least
in the foreign arena. However, it has to be done in partnership
with people, so we strongly value our partnerships with the
Federal Government, as we have mentioned in our testimony, and
we value their input and guidance for how best to extend the
information to State and local authorities as well as other
countries and NGOs.
I am not a fan of rolling out disruptive technology like
this before it is ready. This program needs a lot of human
time. It needs basically for me to sit down with, say, city
officials in San Francisco and say, Folks, how do you do
business? How might this information help you? When is it too
much information? What are your reporting priorities? What are
your concerns? How many people do you have to do this? Do you
have the bandwidth to handle receiving this information?
At the end of the day--and it may take us years to get
there--this information has to get all the way down to the
individual health care provider regardless of what organization
they belong to, and that includes veterinarians as well as
agriculturalists. To get there from here, though, again, this
is going to require a lot of culture change, a lot of dialogue,
a lot of socialization of the technology, and that is just
something that you really just cannot rush.
The problem, of course, that we have is that Mother Nature
may not wait for that, so we are kind of in a race against
time, if you will, to figure out the best solution possible.
And this is why we do this with our partners, and we do not
operate in a vacuum.
Senator Akaka. Thank you.
Dr. Flesness, human disease surveillance in developing
countries is traditionally weak. This is why programs such as
those implemented by AID, CDC, and DOD are so important.
However, one could imagine that animal disease surveillance in
developing countries is even more weak.
What are your thoughts about bringing ZIMS to developing
countries and in helping these countries develop better disease
surveillance?
Mr. Flesness. Thank you, Mr. Chairman. ISIS has been
expanding its membership network for the 34 years it has
existed, and we attend national and regional conferences of the
zoos in Latin America, Asia, Africa, and so on. So we have
gotten to know many of the people in the institutions who would
like to become members of this global network. So we know that
there is interest and will and even friendships.
The two obstacles that remain are essentially financial:
One is access to technology and technology transfer. That is
both IT and lab and veterinary. And the other is our annual
membership dues, which average about $4,000 per year per
institution. In the developing world, that is a problem. There
are about 500 institutions that we do not yet have to add to
our 700. We estimate there are 1,200 quality zoos and aquariums
in the world. We would like to bring them in. That would
require a couple of million dollars a year subsidy.
Senator Akaka. Yes. Well, I want to thank all of our
witnesses. It is my hope that the work each of your
organizations is doing will help our country and the U.S.
public health officials ensure that any potential health threat
to Americans is caught early and dealt with effectively. As
with all programs, there is always room for improvement. I hope
that the discussion of these activities today has helped
identify some of those places where more work can be done.
Situational awareness is central to our efforts to secure the
homeland. Global disease surveillance is very much a part of
these efforts. We must ensure that these activities are
effective and also that they yield results, particularly over
the long term. And your contribution to this hearing will
certainly be helpful in our work in bringing this about.
I want to thank you all. There may be questions from other
Members who will submit them for your responses. I want to
thank you for being part of this hearing and contributing as
you have. The hearing record will be open for 1 week for these
Members to ask questions.
The hearing is adjourned.
[Whereupon, at 4:16 p.m., the Subcommittee was adjourned.]
A P P E N D I X

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PREPARED STATEMENT OF SENATOR LIEBERMAN

October 4, 2007

Thank you, Mr. Chairman.
And thank you for holding this important hearing on the United
States' preparedness and efforts to combat infectious disease. As
stated by Dr. Margaret Chan, director of the World Health Organization,
``International public health security is both a collective aspiration
and a mutual responsibility.''
A growing world population combined with the ease of global travel
and a warming planet has lowered the barriers to the spread of
infectious disease and now more than ever the United States must work
cooperatively to identify and effectively respond to emerging threats.
As our panel of witnesses illustrates a number of agencies are working
on securing the United States by building capacity for the surveillance
and detection of emerging infectious diseases overseas. The GAO report
released in conjunction with this hearing says that the U.S. has
invested approximately $84 million in this effort over the last two
years. However, thee is still work to be done.
Not only are diseases emerging at an unprecedented rate, but an
overwhelming proportion of these diseases are zoonotic. Avian
influenza, West Nile, SARs, and HIV/AIDS are recent and devastating
examples of the impact animal born diseases can have when they
transition to humans.
The appearance of zoonotic diseases in humans is prevalent in
developing countries, where trade in wild animals is concentrated.
Therefore, ti is important for the U.S. to have a strong presence in
these countries to allow for the training of individuals and the
sharing of data. USAID and CDC have been successfully collaborating
with the Wildlife conservation Society through the Global Avian
Influenza Network for Surveillance (GAINS) in 28 countries detecting
disease in wild bird populations.
While this disease specific program has proven successful it is
just the tip of the iceberg--a key to preventing a pandemic is early
detection. Surveillance of an array of wildlife populations will
increase our ability to fight the next emerging disease as we will have
a better understanding of our enemy. For this reason, my colleagues,
Senators Akaka and Brownback, and I have introduced legislation to
expand the collaboration of USAID and CDC with the Wildlife
Conservation society to address the need for a global wildlife disease
surveillance system.
We must prevent the outbreak and spread of new zoonotic diseases
that have no treatments or cures to save the next generation from
suffering the pain millions have faced from HIV/AIDS and avian
influenza.
Thank you, Mr. Chairman.

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