Mr. Chairman and Members of the Subcommittee, I am Scott R. Lillibridge, Special Assistant to the Secretary of HHS for National Security and Emergency Management. I appreciate the opportunity to appear before you this morning to discuss the Department of Health and Human Services (HHS) role in State and local government preparedness to respond to acts of terrorism involving biological or chemical agents.

State and local public health programs comprise the foundation of an effective national strategy for preparedness and emergency response. Preparedness must incorporate not only the immediate responses to threats such as biological and chemical terrorism, it also encompasses the broader components of public health infrastructure which provide the foundation for immediate and effective emergency responses. These components include:

A well trained, well staffed, fully prepared public health workforce;

Laboratory capacity to produce timely and accurate results for diagnosis and investigation;

Epidemiology and surveillance, which provide the ability to rapidly detect heath threats;

Secure, accessible information systems which are essential to communicating rapidly, analyzing and interpreting health data, and providing public access to health information;

Communication systems that provide a swift, secure, two-way flow of information to the public and advice to policy-makers in public health emergencies;

Effective policy and evaluation capability to routinely evaluate and improve the effectiveness of public health programs; and Preparedness and response capability, including developing and implementing response plans, as well as testing and maintaining a high-level of preparedness.

Currently, most states need public health infrastructure improvements in order to effectively prepare for and respond to possible future attacks. In addition, health officials must ensure that critical public health functions continue despite the diversion of resources to any existing emergency.

Preparedness and Response

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 to respond to biological and chemical terrorism. For example, 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 as part of its overall Bioterrorism Preparedness and Response Program. In addition, CDC currently funds 9 states and 2 metropolitan areas specifically to develop public health preparedness plans for their jurisdictions. Many of these states and cities have participated in exercises to test components of their plans. We must continue to work with our state and local public health systems to make sure they are more prepared. This will require the interaction of state departments of health with state emergency managers to fully integrate the state's capacity to effectively distribute life-saving medications to victims of a biological or chemical terrorism event.

The HHS Office of Emergency Preparedness is also working on a number of fronts to assist local hospitals and medical practitioners to deal with the effects of biological, chemical, 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 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; the capability to distribute 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.

Lessons Learned from Preparedness Exercises

An indication of the Nation's preparedness for bioterrorism was provided by the congressionally mandated Top Officials (TOPOFF) 2000 Exercise in May 2000. This national drill involved scenarios related to a weapons-of-mass-destruction-attack against our populations. However, the exercise simulating a plague outbreak in Denver is most important to our discussion today. This exercise involved the state and local community, FEMA, DOJ, HHS, DOD and many other vital community sectors that would play a role in ab actual response. While much progress has been made to date, a number of important lessons from that event have begun to shape our plans about bioterrorism preparedness and response in the health and medical area. They are as follows:

Improving the public health infrastructure remains a critical focus of the bioterrorism preparedness and response efforts. Such preparedness is indispensable for reducing the Nation's vulnerability to terrorism using infectious agents and other potential emergencies through the development of broad public health capacities. We need to increase the current very limited surge capacity in our healthcare system. Local health care systems must be able to expand their health care capacity rapidly in the face of mass casualties. This must be part of our overall preparedness effort for infectious diseases and other major health emergencies. Local communities will need assistance with the distribution of stockpile medications and will greatly benefit from additional planning related to epidemic response. It will be extremely important to link emergency management services and health decision making at the state and local level for the purpose of rapidly addressing the needs of large populations affected by an epidemic. Training health workers to understand emergency management tools like the Incident Command System (ICS) is an example of the type of effort that will be important in closing this gap. Ensuring that the proper legal authorities exist to control the spread of disease at the local, state and Federal level and that these authorities can be exercised when needed. This will be important to our efforts to control the spread of disease. Lastly, Federal "response partners" in the health and medical arena need to design response contingencies that specifically address the needs of victims of large-scale epidemics 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. But there is more we can 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 biological or chemical terrorist attack.

Mr. Chairman, that concludes my prepared remarks. I would be pleased to answer any questions you or members of the Subcommittee may have.