Mr. Chairman and Members of the Subcommittee, thank you for inviting me here today to discuss the Department of Health and Human Services (HHS) preparedness to respond to acts of terrorism involving biological agents.
Among weapons of mass destruction, bioterrorism features several characteristics that set it apart from other acts of terrorism involving, for example, explosives or chemical agents. While explosions or chemical attacks cause immediate and visible casualties, an intentional release of a biological weapon would unfold over the course of days or weeks, culminating potentially in a major epidemic. Until sufficient numbers of people arrive in emergency rooms, doctors' offices and health clinics with similar illnesses, there may be no sign that a bioterrorist attack has taken place.
Three important points must be considered in bioterrorism preparations. First, biological agents are easy to conceal. A small amount may be sufficient to harm large populations and cause epidemics over a broad geographic region. Second, the contagious nature of some infectious diseases means that once persons are exposed and infected they can continue to spread the disease to others. Third, in the most worrisome scenario of a surreptitious attack, the first responders are likely to be health professionals in emergency rooms, physician offices, outpatient clinics, public health settings, and other health-care activities rather than the traditional first responders. The longer the terrorist-induced epidemic goes unrecognized and undiagnosed, the longer the delay in initiating treatment and other control efforts to prevent further infectious outbreaks.
The broad goals of a national response to bioterrorism, or any epidemic involving a large population will be to detect the problem, control the epidemic's spread and treat the victims. HHS's approach to this challenge has been to strengthen public health infrastructure to deal more effectively with epidemics and other emergencies, and to hone our emergency health and medical response capacities at the federal, state and local level. HHS has also worked to forge new partnerships with organizations related to national security.
What has HHS been doing to prepare for this kind of event? Our efforts are focused on improving the nation's public health surveillance network to quickly detect and identify the biological agent that has been released; strengthening the capacities for medical response, especially at the local level; expanding the stockpile of pharmaceuticals for use if needed; expanding research on disease agents that might be released; developing new and more rapid methods for identifying biological agents and improved treatments and vaccines; improving information and communications systems; and preventing bioterrorism by regulation of the shipment of hazardous biological agents or toxins.
Several HHS agencies play a key role in our preparedness for terrorist events, including the Office of Emergency Preparedness (OEP), the Centers for Disease Control and Prevention (CDC), the Food and Drug Administration (FDA), and the National Institutes for Health (NIH).
In order to advance an orderly and comprehensive approach to the many issues involved in such preparation, in July of this year I appointed a special assistant within the Immediate Office of the Secretary to lead the Department's bioterrorism initiative. I have directed this individual, Dr. Scott Lillibridge, to begin creating a unified HHS preparedness and response system to deal with these important issues. Under my direction, Dr. Lillibridge will provide executive leadership and organizational direction for HHS budget, policy, and program implementation on terrorism preparedness issues. Let me assure you that this is a top priority for me and for my entire Department.
We are striving at HHS to strengthen our readiness and response, and our ability to respond has been greatly improved over the last several years. The system is not perfect, however, and we must continue to accelerate our preparedness efforts.
If a terrorist used a biological or chemical weapon against the civilian population, how quickly the outbreak is detected, analyzed, understood and addressed would be the responsibility of state and local public health jurisdictions and the Centers for Disease Control and Prevention.
The CDC has used funds provided by the past several congresses to begin the process of improving the expertise, facilities and procedures of state and local health departments and within CDC itself related to bioterrorism. CDC has established a Bioterrorism Preparedness and Response Program within its National Center for Infectious Diseases to direct and coordinate their activities. CDC has a dedicated anti-bioterrorism staff of more than 100 full-time professionals comprising expertise in epidemiology, surveillance, and laboratory diagnostics.
Over the last three years, the agency has awarded more than $130 million in cooperative agreements to 50 states, one territory and four major metropolitan health departments to support,
Preparedness planning and readiness assessment;
Epidemiology and surveillance;
Laboratory capacity for biological or chemical agents; and
The Health Alert Network (a nationwide, integrated, electronic communications system).
The CDC has launched an effort to improve public health laboratories that likely would be called upon to identify a biological or chemical attack. The Laboratory Response Network (LRN), a partnership among the Association of Public Health Laboratories (APHL), CDC, FBI, State Public Health Laboratories, DOD and the Nation's clinical laboratories, will help ensure that the highest level of containment and expertise in the identification of rare and lethal biological agents is available in an emergency event. The LRN also includes the Rapid Response and Advanced Technology Laboratory at CDC, which has the sole responsibility of providing rapid and accurate triage and subsequent analysis of biological agents suspected of being terrorist weapons.
The CDC is also working to provide coordinated communications in the public health system, between federal agencies and between public health officials and the public itself. To this end, CDC has the Epidemic Information Exchange (EPI-X). The EPI-X is a secure, Web-based communications network that will strengthen bioterrorism preparedness efforts by facilitating the sharing of preliminary information about disease outbreaks and other health events among officials across jurisdictions and provide experience in the use of a secure communications system.
CDC has invested $90 million in the Health Alert Network (HAN), a nationwide system that will distribute health advisories, prevention guidelines, distance learning, national disease surveillance information, laboratory findings and other information relevant to state and local readiness for handling disease outbreaks. HAN provides high-speed Internet connections for local health officials; rapid communications with first responder agencies and others; transmission of surveillance, laboratory and other sensitive data; and on-line, Internet- and satellite-based distance learning. With the addition of several recent awards, CDC has provided HAN funding and technical assistance to 50 state health agencies, Guam, the District of Columbia, three metropolitan health departments and three exemplar Centers for Public Health Preparedness.
CDC also manages the National Pharmaceutical Stockpile (NPS), which provides us with the ability to rapidly respond to a domestic biological or chemical terrorist event with antibiotics, antidotes, vaccines and medical materiel to help save lives and prevent further spread of disease resulting from the terrorist threat agent. The NPS Program provides an initial, broad-based response within 12 hours of the federal authorization to deploy, followed by a prompt and more targeted response as dictated by the specific nature of the biological or chemical agent that is used. The first emergency deployment of the NPS occurred in response to the tragedy in New York city.
Because food may be a likely medium for spreading infectious diseases, FDA as well as CDC have enhanced their surveillance activities with respect to diseases caused by foodborne pathogens. PulseNet, a national network of public health laboratories created, administered and coordinated by CDC in collaboration with FDA and USDA, enables the comparison of bacteria isolated from patients from widespread locations, from foods and from food production facilities. This type of rapid comparison allows public health officials to connect what may appear to be unrelated clusters of illnesses, thus facilitating the identification of the source of an outbreak caused by intentional or unintentional contamination of foods.
HHS coordinates and provides health leadership to the National Disaster Medical System (NDMS), which is a partnership that brings together HHS, DOD, FEMA, and the Department of Veterans Affairs (VA). The NDMS provides medical response, patient evacuation, and definitive medical care for mass casualty events. This system addresses both disaster situations and military contingencies. More than 7,000 private citizens across the country volunteer their time and expertise as members of response teams to support this effort. This system also includes approximately 2,000 participating non-federal hospitals. VA and DOD's expertise and resources are critical to many key aspects of NDMS response, and I would note that these Departments have distinguished themselves on many occasions.
In most localized disasters, including the scurrilous attacks on the World Trade Centers in New York and the Pentagon here in Washington, HHS organizes its medical field response through the Office of Emergency Preparedness using a team structure. Teams can include Disaster Medical Assistance Teams, specialty medical teams (such as burn and pediatric), and Disaster Mortuary Teams. In addition, National Medical Response Teams are able to deploy to sites anywhere in the country with a supply of specialized pharmaceuticals to treat up to 5,000 patients. Currently, HHS can draw on 27 such teams that can be federalized and deployed to assist victims. Such teams have been sent to many areas in the aftermath of disasters in support of FEMA-coordinated relief activities.
HHS, through OEP, has the capability to mobilize NDMS resources, the Public Health Service's Commissioned Corps Readiness Force, as well as enlist the support of other federal agencies, such as DOD and VA, to help provide needed medical and public health services to treat disaster victims. In the last few years, these assets were deployed to New York, Florida, Texas, Louisiana, Alabama, Mississippi, the Virgin Islands and Puerto Rico in the aftermath of hurricanes and tropical storms, and to New York and Virginia in response to the events of September 11, 2001.
However, regional or national response to a health emergency involving bioterrorism will also require that additional capacities be in place at the state and local level before the disaster strikes. HHS, primarily through CDC, is supporting state and local governments to strengthen their surveillance, epidemiological investigation and laboratory detection capabilities, as well as continuing development of a national stockpile of critical pharmaceuticals and vaccines to supplement local and state resources.
The Office of Emergency Preparedness is working on a number of fronts to assist local hospitals and medical practitioners to deal with the effects of bioterrorism and other terrorist acts. Since Fiscal Year 1995, for example, OEP has been developing local Metropolitan Medical Response Systems (MMRS). Through contractual relationships, the MMRS uses existing emergency response systems - emergency management, medical and mental health providers, public health departments, law enforcement, fire departments, EMS and the National Guard - to provide an integrated, unified response to a mass casualty event. As of September 30, 2001, OEP will has contracted with 97 municipalities to develop MMRSs. The FY 2002 budget includes funding for an additional 25 MMRSs (for a total of 122).
MMRS contracts require the development of local capability for mass immunization/prophylaxis for the first 24 hours following an identified disease outbreak; distribution of materiel deployed to the local site from the National Pharmaceutical Stockpile; local capability for mass patient care, including procedures to augment existing care facilities; local medical staff trained to recognize disease symptoms so that they can initiate treatment; and local capability to manage the remains of the deceased.
HHS has used classroom training, distance learning, and hands-on training activities to prepare the health and medical community for contingencies such as bioterrorism and other terrorism events. For example, in Fiscal Year 1999, Congress appropriated funds for OEP to renovate and modernize the Noble Army Hospital at Ft. McClellan, Alabama, so the hospital can be used to train doctors, nurses, paramedics and emergency medical technicians to recognize and treat patients with chemical exposures and other public health emergencies. Expansion of the bioterrorism component of Noble Training Center curriculum is a high priority for HHS.
HHS has been working closely with the Office of Justice Program's (OJP) National Domestic Preparedness Consortium and we will continue our excellent relationship with them. OJP and HHS have teamed together to develop a healthcare assessment tool and have also delivered a combined MMRS/first responder training program.
CDC has participated with DOD, most notably to provide distance-based learning for bioterrorism and disease awareness to the clinical community. CDC is now moving to expand such training with organizations, such as the Infectious Disease Society of America (IDSA), and Schools of Public Health, such as the Johns Hopkins Center for Civilian Biodefense. The recent FEMA-CDC initiative to expand the scope of FEMA's Integrated Emergency Management Course (IEMC) will serve as a vehicle to integrate the emergency management and health community response efforts in a way that has not been possible in the past. It is clear that these communities can best respond together if they are able to train together toward realistic scenarios that leverage the best of both organizations.
In conclusion, the Department of Health and Human Services is committed to ensuring the health and medical care of our citizens. We have made substantial progress to date in enhancing the nation's capability to respond to a bioterrorist event. And, Mr. Chairman, the Department is prepared to respond! But there is more we can do - - and must do - - to strengthen the response. Priorities include strengthening our local and state public health surveillance capacity, continuing to enhance the National Pharmaceutical Stockpile, and helping our local hospitals and medical professionals better prepare for responding to a bioterrorist attack. Our mission is to accelerate these efforts.
Mr. Chairman, that concludes my prepared remarks. I would be pleased to answer any questions you or members of the Subcommittee may have.
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