Global Health Security Initiative

Thank you, Ambassador [Joseph Gildenhorn, Chairman of the Wilson Center], for that introduction. It’s a pleasure to be here.

Six years ago, we were under attack. Terrorists had struck the World Trade Center and the Pentagon. Then anthrax started appearing in Florida, Washington, and New York.

I was Governor of Utah at the time, and I soon had a closer, more personal brush with the fear of bioterrorism.

On the third or fourth night of the Olympic Games, I was at the figure skating competition, and I got a call from the head of the Department of Public Safety.

“Governor, we need you to come to the Command Center, now. We’ve got a problem — a positive indication of anthrax at the airport.”

As I left the arena, moving as rapidly as I could through the crowd speeding toward the Command Center, a lot of things began to piece together into a scenario in my mind. I was told that it was a monitor that had been placed right at the top of the C Concourse at the Salt Lake International Airport.

It was about 7:00 pm at night. I knew exactly what that meant. Salt Lake City is a major airport hub.

With the traffic of the Olympics, there would be tens of thousands of people arriving on planes, changing planes, walking through the concourse and getting on other planes, and transitioning on to 90 or 100 additional cities.

If the readings were true, not only would those in that airport be contaminated, but literally people traveling to over 100 different cities having received a white powdery substance. They would be in a potential race against death.

It was a frightening moment in that respect. As I said, the scenario played out in my mind.

About 60 days prior to that we had done a sweep of the international airport and found some 200 people who were there without proper documentation. It was just after 9/11 and so we were all hypersensitive about terror coming here for the first time.

I could imagine a cell that had been put into place well in advance of the Olympic Games, knowing that it would be the focus of the world.

I imagined one of these people getting active and slipping something into the ventilator system of the airport laced with anthrax, quietly, silently, without notice.

It was a dramatic moment because I had been told that the same monitor had not only been tested once it had been tested four times. It had tested positive all four times. But the more definitive test was at the lab. And I would not know for the next two-and-a-half hours, if it was anthrax or simply a false read.

As Governor, I had the benefit of having the best people on the ground who could advise me. We concluded after consultation that rather than close the airport, we should call in the Hazmat teams and have them positioned and ready for action, knowing full well that if we had to close the airport, it would have changed the focus for 3 ½ billion people from the humanitarian event of the Olympics to a terrorist event, whether it was true or not.

Likewise, we had the possibility that if it were true, and we didn’t close the airport, we would needlessly subject thousands of people — tens of thousands of people all in cities all over America — to the substance. 

We made the right decision. We had the Hazmat teams in place for two-and-a-half hours. I stood outside the laboratory waiting for the definitive read.

The best news call I had all those Olympics was the notification that it was a false read. But it was a live fire exercise. And the fear of terrorism, and the possibility of bioterrorism, became quite evident to me, as I’m sure it has all of you.

Very few people heard about that event because it proved to be a false alarm. But it taught me a lot about the threat of anthrax. It also impressed on me the importance of preparedness.

Preparedness is a process of learning, adapting, and growing. We’re facing new threats from new weapons. And we’ve got to respond with new ways of working together.

This week senior representatives of eight allied nations plus the European Commission and World Health Organization have gathered here in Washington for the seventh annual meeting of the Global Health Security Initiative. Since 2001, this initiative has been bringing together health ministers, senior officials, and technical experts to address the threat of bioterrorism and pandemic disease.

These are action-oriented meetings. We don’t just get together and talk. We identify joint health-security needs and decide on courses of action we can take together to fill those needs.

Before 9-11, this collaboration wasn’t happening. G-8 finance ministers and foreign ministers met several times a year, but there was no similar gathering of health ministers to discuss health security. We met informally once a year on the margins of the World Health Assembly, but we weren’t working with our leading allies on major threats to world health.

9-11 and the subsequent anthrax attacks in Washington were the catalysts of our collaboration. In the weeks that followed, my predecessor as Secretary of HHS reached out to his counterparts for help in planning defenses against bioterrorism.

The first meeting of the Global Health Security Initiative was held in Ottawa in November, 2001 — less than two months after the terrorist attacks of 9-11. Eight nations sent their ministers of health: Canada, France, Germany, Italy, Japan, Mexico, the United Kingdom, and the United States. In addition, the European Union sent its Commissioner of Health and Consumer Protection.

At the end of the meeting, the nine ministers issued a joint statement condemning all forms of biological, chemical, and nuclear terrorism. They also committed their governments to forming a new partnership to address the critical issue of protecting public health against such threats.

Since then, we have made great strides together:  

• We have expanded our concerns beyond bioterrorism to include other global health threats like pandemic influenza.
• We have launched a new international network of major research labs to connect researchers to their counterparts in other countries.
• We have created an Emergency Contact Network that keeps health officials in each country in touch at all times, 24/7.
• We have devised a “risk incident scale” so governments can let other governments know just how dangerous a particular incident is.
• We have briefed each other on lessons learned from major incidents like the London bombings and Hurricane Katrina.
• We have supported and encouraged the work of the World Health Organization pertaining to health security.
• And we have held exercises and workshops on a wide range of topics — from the dangers of “Q fever” to the best ways to isolate infectious patients.

These are just some of the things member countries have done to improve to emergency preparedness. On their own, they have done much more. The United States, in particular, has made major advances in preparedness since 9-11.

One very visible change is right outside my office. What used to be a conference room is now a high-tech operation center, staffed around the clock by officers of the U.S. Public Health Service.

The Secretary’s Operation Center exists to make sure we are never caught off guard by a health emergency and to coordinate our national and international response.

We have also developed a strategy and a plan of action for medical countermeasures.

• We have stockpiled necessary medical supplies.
• We have organized, equipped, and trained response teams.
• We have modernized the size and structure of the Commission Corps itself.
• And we have conducted planning sessions for regional responders all around the country.

This represents a major change in the mission of HHS. We’ve become much more about emergency preparedness. So we have also reorganized our senior leadership to give preparedness the prominence it deserves.

Last December, Congress passed the Pandemic and All Hazards Preparedness Act. This act established the Office of the Assistant Secretary for Preparedness and Response, or ASPR.

The President appointed Rear Admiral Craig Vanderwagen to be the country’s first ASPR. Admiral Vanderwagen’s job is to coordinate the nation’s preparedness and response. In health emergencies, he is also my Department’s “Incident Commander.”

The same act of Congress transferred the National Disaster Medical System from the Department of Homeland Security to Health and Human Services. It also established the Biomedical Advanced Research and Development Authority, or BARDA.

BARDA is charged with overseeing the development, licensing, and stockpiling of medical countermeasures. A new National Biodefense Science Board will provide BARDA with scientific and technical advice on preparedness and response. 

I mentioned a moment ago that preparedness is a process of learning, adapting, and growing. New threats are bound to appear. A few years ago, a deadly “bird flu” began its creep around the world.

The media buzz has died down, but the H5N1 virus has not. The avian influenza is still highly pathogenic, and it is still affecting people overseas.

Two years ago this week, President Bush mobilized the nation to prepare for a pandemic. Since then, the Federal Government has made great progress in building up the nation’s defenses and planning for the future.

• We have licensed the first H5N1 vaccine for humans and stockpiled enough antiviral medicine to treat 40 million Americans.
• We have committed over $1 billion to expand cell-based influenza vaccine production.
• We have invested heavily in clinical research here at home and surveillance programs around the world.
• We have held 50 flu summits around the country, one in every state.
• We hosted our first “blog summit” on pandemic preparedness last June.
• We have launched a government-wide web site — pandemicflu.gov.
• And we produced and aired a series of television, radio ads, and other materials to alert the public.

Now, I don’t want to give anyone the idea that the federal government has taken care of pandemic preparedness. We are doing what we can. But much of our response to emergencies must be local.

There needs to be preparedness at every level. Every county, every business, every school, every church, every household needs a plan. Every individual can do something, even if it’s just stockpiling necessities or adopting good public-health habits like frequent hand-washing.

Many of our efforts are directed at involving others in pandemic preparedness. I have personally gone door-to-door delivering response kits to neighborhoods in Philadelphia. We are testing to see whether the U.S. Postal Service can be used to distribute antibiotics in the wake of a bioterrorist attack.

Is all this really necessary?

Well, let me just say, pandemics happen. We’ve had three of them in the last hundred years. We’ve had ten of them in the last three hundred years. The last major pandemic we had was 1918. Forty million people across this planet died. If we had one that deadly today, as many as two million Americans would die.

Pandemics are earthshaking events. They reshape societies, they reshape economies, and they reshape geopolitics.

So where do we go from here?

Today’s meeting of senior policy officials will focus on three issues.

One is the importance of virus sample sharing. We need to continue encouraging nations around the world to share samples of influenza viruses. Without sample sharing, it is harder for us to track the spread of viruses or develop new vaccines for new virus.

The United States strongly supports the World Health Organization’s efforts to meet the global need for influenza vaccine. We have provided $10 million to the WHO to help companies in developing countries learn how to produce vaccine. We have also invested heavily in vaccine research and in expanding our own production capacity.

At the same time, we cannot let our efforts to make vaccines more available compromise the integrity of the 50-year-old WHO Global Influenza Surveillance Network. The network provides the world with early warning of evolving flu viruses. All nations therefore have a responsibility to share data and virus samples. The revised International Health Regulations make this very clear.

Recently Indonesia has been withholding virus samples for the purpose of securing royalties from the vaccines that could be produced form these samples. This is an impractical, dangerous, and I might add selfish notion that cannot be accepted by the world.

Responding to a pandemic will demand the cooperation of the entire world community. No nation can go it alone.

The second major topic of discussion is medical countermeasures for chemical, biological, and radiological threats.

Development of such countermeasures poses significant risks. Costs are high, and the rewards are policy dependent.

For some time, the United States Government has been the principal underwriter of development of medical countermeasures. But we can’t continue to bear this burden alone.

It is neither appropriate nor sustainable for the United States Government to continue as the principal source of funding for countermeasure development.

Instead, GHSI members must work together to develop a global marketplace for medical countermeasures. Only a global market can ensure continued development of these critical commodities.

The third major topic is a new one for the GHSI. It’s food and import safety.

The world economy has changed a lot in the last couple of decades. And trading nations now face the challenge of ensuring the safety of both exports and imports.

There are two concerns here: One is bringing producing nations up to the same high level of safety and quality. The other is protecting the supply chain from tampering by terrorists.

Last July, President Bush asked me to chair an Interagency Working Group on Import Safety. The group was tasked to conduct an across-the-board review of products that are imported into this country from around the world.

I personally visited more than two dozen cities. I’ve been to ports and post offices, railroads and airports. I’ve seen freight hubs and border crossings and wholesale retailers and fruit stands. I’ve observed the processing of fish, vegetables, and drugs. I’ve inspected everything from imported tire irons to gingerbread houses.

The sheer magnitude of the import-export enterprise is astounding. This year, more than $2 trillion worth of products will be imported into the United States. That’s nearly twice the size of the economy of Brazil.

These products come from 825,000 importers. They come through 300 ports and land border crossings, postal facilities and other points of entry.

One thing became clear on our trips: We cannot simply inspect our way to product safety. Doing so would bring the international trade of this country to a standstill. It would also divert limited resources from the imported goods posing the greatest risk.

Instead, we found that we need to treat imports much like we treat patients in health care: First, we focus on preventing harm in the first place, then intervening when risks are identified, and lastly, responding rapidly when things go wrong. Prevention, intervention, and response — all three are needed.

We are already reaching beyond our borders to build safety into the process. We are offering the world our product afety expertise. We are telling producers, if you want access to American consumers, you must meet the standards of safety and quality that Americans expect. Producers that don’t meet high standards will find their products disadvantaged in the world market.

Our collaboration with the Government of China has been especially productive. We are working with Chinese officials on two binding agreements on product safety. One is on food and feed; the other is on drugs and devices. Our goal is to sign both agreements this December at the third session of the U.S.-China Strategic Economic Dialogue in Beijing.

These agreements will create a framework to assure the safety and quality of products exported from China to the United States. They also aim to strengthen China’s regulatory process and increase cooperation and information-sharing between the regulatory bodies of both nations.

Import safety will only grow in importance as new exporting economies grow. We believe the issue is a logical extension of the GHSI’s concern for global health security. And we would like to see GHSI members take an active role in establishing a worldwide consensus on product safety.

There are many other issues that still require work. But we have made substantial progress with the issues we have already identified. And I am confident that we are on the right track, with the right organizational approach.

We remain committed to strengthening global health security. And we know that all of our countries are safer thanks to the work of this Initiative.

Now I’d like to open the floor up to your comments and questions.

Last revised: March 13, 2008