I would like to thank you all 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 Federal Executive Boards in responding to an outbreak, and on Thursday afternoon, we will discuss global surveillance of emerging infectious diseases.

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 (CDC) estimate that a flu pandemic could kill between 2 and 7.4 million people worldwide. In the U.S., 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 five million people, 340,000 federal employees, 40 colleges and universities, and 27 hospitals. The NCR hosts the second largest rail transit system in the country and 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. And in the past few years, we have spent millions of dollars through Department of Homeland Security (DHS) and Health and Human Services (HHS) grants to prepare the NCR for natural disasters, public health emergencies, pandemics, and potential terrorist attacks.

According to the World Health Organization, since 1997, 328 people from Southeast Asia to Africa and Europe have been killed as a result of the bird flu or H5N1 virus strain. In response to the growing threat, the CDC and HHS have granted Maryland, Virginia, and the District a total of nearly $19 million in FY06 and FY07 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 FY06 to work with the States on stockpiling anti-viral 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 of 2006, the White House released a National Strategy for Pandemic Influenza. In addition, the local jurisdictions in the 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 disaster, there is no strategic plan specifically for pandemic influenza. I think this would be a useful tool to develop.

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 pandemic influenza outbreak.

I am pleased to hear that D.C. will host an exercise with non-profits 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. 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 how challenging interoperability is with so many jurisdictions in the region. I believe you all have made great strides in this area. I 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. I understand that D.C., 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 governments and 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 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.