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Testimony
Before
the Committee on Governmental Affairs and Subcommittee on
International Security, Proliferation and Federal Services
United
States Senate
Federal
Efforts to Coordinate and Prepare for Bioterrorism: The
HHS Role
Statement of
Tommy
G. Thompson
Secretary,
Department
of Health and Human Services
For Release
on Delivery
Expected
at 9:30 am
on
Wednesday, October 17, 2001
Mr. Chairman and Members
of the Committee, thank you for inviting me here today to
discuss the Department of Health and Human Services (HHS)
role in federal government efforts to coordinate, prepare
for and respond to acts of terrorism, particularly those
involving biological or chemical agents.
The
Federal Emergency Management Agency (FEMA), as overall lead
federal agency for consequence management efforts, has designated
the Department of Health and Human Services (HHS) as the
lead agency to coordinate medical assistance in national
emergencies, be they natural disasters or acts of terrorism.
When FEMA determines a federal response is warranted, this
agency deploys medical personnel, equipment, and drugs to
assist victims of a major disaster, emergency, or terrorist
attack. Given our critical medical role in any biological,
chemical, radiological or nuclear attack, I take HHS preparedness
efforts most seriously.
We are working very closely
within the Administration to make sure our resource needs
are adequately and accurately developed. Areas we have particularly
focused on include:
- Accelerating development
and procurement of vaccines and pharmaceuticals to control
and treat critical biological threats, including smallpox
and anthrax.
- Protecting our food supply
by increasing inspections of food imports, and providing
the Food and Drug Administration (FDA) more of the modern
equipment needed to detect select agents.
- Working with cities to
ensure that their Metropolitan Medical Response System
units have the equipment and training to respond to bioterrorist
events and other disasters.
- Working with States to
ensure they have comprehensive response plans, and increasing
their capacity to detect and respond to threats. This
includes:
-
expanding the number of State labs with rapid testing
capability;
-
improving coordination
with local response plans, and
-
expanding the Health
Alert Network.
- Implementing a new hospital
preparedness effort to ensure that our health facilities
plan for the equipment and training to respond to mass
casualty incidents.
Recent events involving anthrax
have highlighted the collaboration between state and local
health and law enforcement officials, HHS's Centers for
Disease Control and Prevention (CDC) and the Federal Bureau
of Investigation (FBI). We are continuing to conduct investigations
related to anthrax exposures in Florida, New York, Nevada,
and our Nation's Capitol complex. CDC and state and local
health officials continue to work closely with medical professionals
nationwide to monitor hospitals and out-patient clinics
for any possible additional anthrax cases. During this heightened
surveillance, cases of illness that may reasonably resemble
symptoms of anthrax will be thoroughly reviewed until anthrax
can be ruled out.
The public health and medical
community continue to be on a heightened level of disease
monitoring. This is an example of the disease monitoring
system in action, and that system is working.
Coordinated Preparedness
Efforts
As you know, much of the
initial burden and responsibility for providing an effective
response by medical and public health professionals to a
terrorist attack rests with local governments. If the disease
outbreak reaches any significant magnitude, however, local
and state resources will be overwhelmed and the federal
government will be required to provide protective and responsive
measures for the affected populations.
HHS agencies that play a
key role in our Department's overall terrorism preparedness
include the CDC, the FDA, the Office of Emergency Preparedness
(OEP), and the National Institutes of Health (NIH).
The Department has always
valued the cooperation that it has received from its federal,
state, and local government partners. We work closely with
all of the agency signatories of the Federal Response Plan
and have had a particularly close working relationship with
FEMA, the Department of Defense (DOD), the Department of
Justice (DOJ), the Department of State (DOS), the Department
of Veterans Affairs (VA), the U.S. Department of Agriculture
(USDA), the Department of Energy (DOE), and the Environmental
Protection Agency (EPA).
I will focus the remainder
of my testimony on a few examples of HHS's terrorism preparedness
efforts conducted in collaboration with our federal, state,
and local partners.
National Disaster
Medical System
The National Disaster Medical
System (NDMS) is the vehicle for providing resources for
meeting the medical, mental health, and forensic service
requirements in response to major emergencies, federally
declared disasters, and terrorist acts. Begun in 1984, NDMS
is a partnership among HHS, VA, DoD, FEMA, state and local
governments, and the private sector. The System has three
components: direct medical care; patient evacuation; and
the non-federal hospital bed system. NDMS was created as
a nationwide medical response system to supplement state
and local medical resources during disasters and emergencies,
to provide back-up medical support to the military and VA
health care systems during an overseas conventional conflict,
and to promote development of community-based disaster medical
systems. The availability of beds in over 2,000 civilian
hospitals is coordinated by VA and DoD Federal Coordinating
Centers. The NDMS medical response component is comprised
of over 7,000 private sector medical and support personnel
organized into approximately 70 Disaster Medical Assistance
Teams, Disaster Mortuary Operational Response Teams, and
speciality teams across the Nation.
When there is a disaster,
FEMA, as the Nation's consequence management and response
coordinator, tasks HHS to provide critical services, such
as health and medical care; preventive health services;
mental health care; veterinary services; mortuary activities;
and any other public health or medical service that may
be needed in the affected area. HHS's Office of Emergency
Preparedness directs NDMS, the Public Health Service's Commissioned
Corps Readiness Force, and other federal resources, to assist
in providing the needed services to ensure the continued
health and well-being of disaster victims.
Pharmaceutical
Stockpiles
The VA is one of the largest
purchasers of pharmaceuticals and medical supplies in the
world. Capitalizing on this buying power, OEP and VA have
entered into an agreement under which the VA manages and
stores specialized pharmaceutical caches for OEP's National
Medical Response Teams. The VA has purchased many of the
items in the pharmaceutical stockpile. The VA is also responsible
for maintaining the inventory, ensuring its security, and
rotating the stock to ensure that the caches are ready for
deployment with the specialized National Medical Response
Teams. Additionally, during FY 2001, OEP provided funds
to the VA to begin to develop plans and curricula to train
NDMS hospital personnel to respond to weapons of mass destruction
events.
Research Efforts
With the support of Congress,
the President has implemented a government-wide emergency
response package to help deal with the tragic events of
September 11th. This complements efforts already underway
to prepare our nation against such heinous attacks, including
threats of bioterrorism. For example, CDC and the National
Institutes of Health (NIH) within HHS are collaborating
with the Department of Defense (DOD) and other agencies
to support and encourage research to address scientific
issues related to bioterrorism. The capability to detect
and counter bioterrorism depends to a substantial degree
on the state of relevant medical science. In some cases,
new vaccines, antitoxins, or innovative drug treatments
need to be developed or stocked. Moreover, we need to learn
more about the pathogenesis and epidemiology of the infectious
diseases which do not affect the U.S. population currently.
We have only limited knowledge about how artificial methods
of dispersion may affect the infection rate, virulence,
or impact of these biological agents. Our continuing research
agenda in collaboration with CDC, NIH, and DOD is vital
to overall preparedness.
Even before the events of
September 11, HHS's Food and Drug Administration actively
cooperated with DOD in the operation of its vaccine development
program and the maintenance of their stockpile program.
Any vaccine development, whether by DOD or private industry,
must be in accordance with FDA requirements that ensure
the safety, effectiveness and manufacturing quality of the
finished product. FDA provides assistance to DOD regarding
the research required to develop new vaccines, as well as
assistance during all phases of development. FDA also works
with DOD's office that screens new and unusual ideas for
development of products to treat diseases and develop diagnostic
tools.
Food Safety
Because food is a possible
medium for spreading infectious diseases, FDA and CDC are
enhancing their surveillance activities with respect to
diseases caused by foodborne pathogens, and are working
with our federal, state, and local partners to coordinate
these activities. 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.
FDA also works with the EPA,
the Nuclear Regulatory Commission and other agencies to
address chemical and nuclear food safety issues of concern.
Training
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. Working with CDC and
the VA, a training program was developed for pharmacists
working with distribution of the National Pharmaceutical
Stockpile. 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 Programs (OJP) National Domestic
Preparedness Consortium, and we will continue our excellent
relationship with them. OJP and HHS have teamed together
to develop a health care 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.
Because the initial detection
of a biological terrorist attack will most likely occur
at the local level, it is essential to educate and train
members of the medical community - both public and private
- who may be the first to examine and treat the victims.
It is also necessary to upgrade the surveillance systems
of state and local health departments, as well as within
healthcare facilities such as hospitals, which will be relied
upon to spot unusual patterns of disease occurrence and
to identify any additional cases of illness. HHS and its
other partners will continue to provide terrorism-related
training to epidemiologists and laboratorians, emergency
responders, emergency department personnel and other front-line
health-care providers, and health and safety personnel.
State and Local
Collaborations
HHS has also had a particularly
close working relationship with local and state public health
and health care delivery communities. We coordinate closely
with the public safety, public health, and health care delivery
communities at all of these levels, particularly through
the health agencies and emergency management authorities.
As key partners in our response
strategy, 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
terrorism, it also encompasses the broader components of
public health infrastructure which provide the foundation
for immediate and effective emergency responses.
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 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.
CDC has invested $90 million
in the Health Alert Network (HAN), a nationwide system that
is now in all 50 states, which 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.
The CDC also has launched
an effort to improve public health laboratories. 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 biological agents is
available in an emergency event.
Metropolitan Medical
Response System
HHS 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, HHS
through 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.
During FY 2002, we intend to award $10 million to 25 additional
cities (for a total of 122) through the MMRS to help them
improve their medical response capabilities.
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.
Conclusion
The Department of Health
and Human Services is committed to working with other federal
agencies as well as state and local public health partners
to ensure the health and medical well-being of our citizens.
The mutual and ongoing consultation, assistance, collaborations
and support HHS receives from its federal agency partners
are useful in identifying not only programmatic overlaps
but also gaps in our preparedness efforts. These efforts
also allow us to work toward integrating our respective
initiatives into a government-wide framework.
Our ongoing relationships
with state and local governments have been reinforced in
recent years as a result of the investments we have made
in bioterrorism preparedness. Without their engagement in
this undertaking, we would not be seeing the advances that
have been made in recent years.
We have made substantial
progress to date in enhancing the nation's capability to
respond to biological or chemical acts of terrorism. But
there is 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, improving public health planning
and preparedness at the state and local level, 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 Committee may have.
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Last revised: October 17, 2001