<DOC>
[109 Senate Hearings]
[From the U.S. Government Printing Office via GPO Access]
[DOCID: f:30041.wais]
S. Hrg. 109-604
PREPARING FOR PANDEMIC FLU
=======================================================================
HEARING
before the
SPECIAL COMMITTEE ON AGING
UNITED STATES SENATE
ONE HUNDRED NINTH CONGRESS
SECOND SESSION
__________
WASHINGTON, DC
__________
MAY 25, 2006
__________
Serial No. 109-24
Printed for the use of the Special Committee on Aging
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30-041 WASHINGTON : 2006
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SPECIAL COMMITTEE ON AGING
GORDON SMITH, Oregon, Chairman
RICHARD SHELBY, Alabama HERB KOHL, Wisconsin
SUSAN COLLINS, Maine JAMES M. JEFFORDS, Vermont
JAMES M. TALENT, Missouri RON WYDEN, Oregon
ELIZABETH DOLE, North Carolina BLANCHE L. LINCOLN, Arkansas
MEL MARTINEZ, Florida EVAN BAYH, Indiana
LARRY E. CRAIG, Idaho THOMAS R. CARPER, Delaware
RICK SANTORUM, Pennsylvania BILL NELSON, Florida
CONRAD BURNS, Montana HILLARY RODHAM CLINTON, New York
LAMAR ALEXANDER, Tennessee KEN SALAZAR, Colorado
JIM DEMINT, South Carolina
Catherine Finley, Staff Director
Julie Cohen, Ranking Member Staff Director
(ii)
C O N T E N T S
----------
Page
Opening Statement of Senator Gordon Smith........................ 1
Opening Statement of Senator Herb Kohl........................... 3
Panel I
Hon. Michael O. Leavitt, Secretary, U.S. Department of Health and
Human Services, Washington, DC................................. 4
Panel II
Nancy Donegan, director of Infection Control, Washington Hospital
Center, Washington, DC; on behalf of the National Hospital
Association.................................................... 27
J. Steven Cline, DDS, MPH, chief, Epidemiology Section, Division
of Public Health, North Carolina Department of Health and Human
Services, Raleigh, NC.......................................... 42
APPENDIX
Prepared Statement of Senator Hillary Rodham Clinton............. 55
(iii)
PREPARING FOR PANDEMIC FLU
---------- --
THURSDAY, MAY 25, 2006
U.S. Senate,
Special Committee on Aging,
Washington, DC.
The Committee met, pursuant to notice, at 10 a.m., in room
SD-G50, Dirksen Senate Office Building, Hon. Gordon H. Smith
(chairman of the committee) presiding.
Present: Senators Smith, Kohl and Carper.
OPENING STATEMENT OF SENATOR GORDON SMITH, CHAIRMAN
The Chairman. Good morning, ladies and gentlemen. We
welcome you to this hearing of the Senate Special Committee on
Aging, and our hearing today is ``Preparing for Pandemic Flu.''
We have heard a great deal in the last several years about
emergency planning and response. The tragedies of September 11
and Hurricanes Katrina and Rita showed us all just how
vulnerable we can be to both man-made and natural disasters.
Applying the lessons we learned from the past, we move forward
with preparing to address the potential threats of tomorrow.
While much may still be unknown about those threats, more and
more indicators suggest that we may soon face a pandemic
outbreak of a new influenza virus.
One does not have to look far back into history to see how
devastating a severe pandemic flu can be to our society. In
1918, Spanish flu killed an estimated 2 percent of the world's
population, mainly the young and the healthy. The milder Hong
Kong flu outbreak in 1968 killed 34,000 in the U.S. alone, and
caused between $71 and $166 billion in economic losses.
We have been fortunate not to experience a catastrophic flu
outbreak for many decades, but the emergence of the highly
aggressive avian flu virus in the late 1990's has generated a
sense of urgency among the world's public health officials.
Just this week, a case of human-to-human transmission of
the avian flu virus was reported in Indonesia. Reports such as
these suggest that the next severe influenza outbreak could be
looming on the horizon. In response to this threat, the United
States has undertaken a significant effort to prepare for the
next pandemic. Just recently, the Homeland Security Council
released a lengthy pandemic influenza implementation plan. This
report provides broad directives for all sectors of our society
to follow in order to effectively prepare for the next flu
outbreak.
I commend the efforts of the administration to put forward
a comprehensive framework for pandemic flu preparedness, but it
is clear we have much yet to do. Biotechnology and
pharmaceutical companies continue to search for a safe and
effective pandemic flu vaccine. Hospitals and other facilities
are developing plans to ensure they have the necessary supplies
and staff to handle a significant influx of patients.
As we move forward with this important work, it is
essential that we keep the special needs of older Americans in
mind. They may be more vulnerable to an infection due to
preexisting health conditions or weakened immune systems. The
more outreach we can do to the elderly in our communities
before an outbreak occurs, the better protected they will be.
I hope we can use today's hearing to delve more deeply into
what needs to be accomplished to safeguard all Americans from
the harms of a pandemic, but especially those most vulnerable,
such as the elderly, the disabled, the chronically ill and
children.
I am very pleased to have my friend and our Secretary,
Secretary Leavitt, with us here today, and I look forward to
your testimony, Mike.
The witnesses we have assembled represent many of the key
parties that will be involved in the initial response to a flu
pandemic. If we have learned anything from the past, it is that
all levels of public and private sectors must coordinate their
efforts to successfully respond to an emergency.
While much is still unknown about the nature of the next
influenza outbreak, we must press forward with implementing a
comprehensive response effort. As Benjamin Franklin once said,
an ounce of prevention is worth a pound of cure. That was true
then and it still true, and it is certainly true as we look
toward this horrible potential event.
In light of today's discussion of pandemic flu
preparedness, I am pleased to join one of my Senate colleagues,
Senator Evan Bayh of Indiana, in filing the All Hazards Public
Health Emergency and Bioterrorism Preparedness and Response
Act. This important legislation will help State and local
communities better respond to the unique public health threats
they might face, and creates new tools to encourage much-needed
public health workforce development. I hope the Response Act
will help guide Congress' discussion of how future public
health planning and response efforts can better safeguard the
health and well-being of our citizens.
So with that, I will turn to my friend and my colleague,
Senator Kohl of Wisconsin.
OPENING STATEMENT OF SENATOR HERBERT KOHL
Senator Kohl. Thank you, Mr. Chairman, for holding this
hearing.
Experts no longer ask if such a pandemic could occur.
Rather, they question when it will occur. Earlier this month,
the White House unveiled its plan for responding to a flu
pandemic. This plan is a constructive first step with at least
many serious questions unanswered, like which Federal agencies
and officials will take the lead in responding to an outbreak
emergency.
I am concerned that we are not prepared to care for the
complex needs of our Nation's seniors, in particular. The
elderly are among our most vulnerable members of society and
they are far too often overlooked or even ignored in emergency
preparedness plans.
Hurricane Katrina illustrated how we failed the seniors who
need us most. Last week, we chaired a hearing in this Committee
where we heard that 71 percent of those who died during Katrina
were over the age of 60. We need to learn the lesson of those
deaths and make sure that any strategy to prepare for pandemic
flu incorporates the unique needs of seniors.
We need to do a better job in telling older people what
supplies and plans they need to have in place in the event of a
national emergency like pandemic flu. As a start, my office has
developed a tip sheet, and HHS and DJS should follow with
pamphlets, public announcements and specific direction for
seniors and the agencies that serve them.
We also must direct States and local governments to include
in all planning, training of first responders and practice
exercises for national emergencies. Communities need plans to
locate and help seniors who live at home if a flu pandemic
occurs.
Federal, State and local governments are making progress in
preparing for potential outbreak, but I believe we need to do
more. Even if we are spared from a flu pandemic, the work that
we do today will serve us all well in the event of any national
emergency. We look forward to hearing from our panels today
about the direction our Nation should follow and what it will
take to deal with pandemic flu, including steps we must take to
care for our seniors.
Again, Mr. Chairman, I thank you for this hearing and we
look forward to hearing from our witnesses.
The Chairman. Mr. Secretary, thank you for being here, and
your staff and others. We appreciate all that you and your
Department have done. We have seen you a lot on TV, and you
obviously know the subject well.
STATEMENT OF HON. MICHAEL O. LEAVITT, SECRETARY, U.S.
DEPARTMENT OF HEALTH AND HUMAN SERVICES, WASHINGTON, DC
Secretary Leavitt. Senator, thank you for holding the
hearing. It is an important subject.
Pandemics happen. They are part of the biologic world. They
are a biologic fact of life. They are part of the microbial
world of viruses and bacteria that are constantly mutating,
constantly finding ways to survive in more and more hosts.
The history of pandemics isn't so much the history of
public health as it is humankind. As you pointed out, we have
periodically throughout history had pandemics. You can go all
the way back to the city of Athens in 430 B.C. and see the
evidence of 25 percent of that great city's population being
wiped out by a pandemic disease. It not only changed the city's
health, but it changed their future. It affected their
politics, it affected their prosperity. It changed the city in
an irretrievable way.
That has been true almost entirely every century. We would
see evidence of two or three of these. The 14th century may be
the best-known--Black Death. Twenty-five million people across
Europe died. Again, it did not just affect the health; it
affected the culture and it affected the politics and the
prosperity of that entire region.
You mentioned the fact that we have had 10 pandemics in the
last 300 years. We have also had three of them in the last 100.
You mentioned 1968 and 1957. They were what the scientists
refer to as relatively small events by pandemic scale. They
were highly efficient viruses; that is to say they spread
quickly, but they were not particularly virulent. Not many
people died.
1918 that you also referenced, on the other hand, was both
efficient--it spread fast--and it was virulent. Lots of people
died, and that, of course, is the type of event that we need to
be prepared for. We hope and pray it will not occur, but that
is the level at which we need to prepare.
We are today concerned properly, in my judgment. Scientists
fear that the H5N1 virus that is spreading across the world on
the backs of wild migratory birds could, in fact, be the spark
of the next pandemic. No one knows with certainty, but the
warning signs are there. We are seeing the capacity for this
virus to jump the species barrier, clearly going from birds to
people. We are also now seeing, and have throughout the history
of this virus, very limited and highly inefficient transmission
between people. You mentioned the circumstance in Indonesia. I
am happy to respond during the questions if you would like to
know more about that.
We are concerned not only because it is widespread; we are
concerned because of its genetic similarity to the 1918 virus.
It is clear by the course of events over the last several years
that this is a aggressive killer once it gets into people, and
so there is reason for us to be concerned. For that reason, the
President has asked that we mobilize the country.
I have been moving throughout the country, having summits
in every State, including Wisconsin and Oregon; in fact, almost
every State now. Tomorrow, I will be in New Hampshire. It will
be our 51st summit. We are doing summits in both the
territories and in the States. These have been rallying events.
More than 20,000 public leaders from the health community, from
local political leaders, from schools, from businesses have
come for the purpose of being able to begin community planning.
It is part of a comprehensive plan. There is no single
action that prepares a community for this kind of an event. It
requires our working on vaccines, on anti-virals, developing
stockpiles, on having community preparedness. At the very
foundation of preparedness, however, is a prepared community.
The fundamental message of our summits has been this, that any
community that fails to prepare, with the expectation that the
Federal Government or even the State government can get to
every community and rescue them at the last moment, will be
sadly and tragically, mistaken not because any of us lack a
will or because we lack a sufficient wallet, but because there
is no way that a government can get to 5,000 communities at the
same time.
That is one of the peculiar and very important distinctions
of a pandemic. It is highly local. It happens everywhere at the
same time, but it is a highly local event. The truth is we are
overdue for a pandemic.
The Chairman. Mike, to that point, could I ask you a
question, because it really is what is on my mind? It is local.
Obviously, even hurricanes are somewhat local, and 9/11 was
local, but are there lessons from those response efforts that
local communities are drawing lessons from that specifically
related to the flu pandemic?
Secretary Leavitt. Senator, in your statement you mentioned
some of the disasters we have endured as a Nation. There are
many lessons to be learned. One of the lessons is that you have
to think about the unthinkable because it happens. Another
important lesson in my mind is that what you do before an
emergency is far more important than what happens after in
terms of being able to prevent injury and damage.
But perhaps the most important will be the difference
between a pandemic and any other natural disaster. Katrina was
a devastating weather disaster. It covered Louisiana,
Mississippi and a piece of Alabama, but at least it was
constrained to that area. A pandemic would not be.
In Katrina, we had people literally come from all over the
country to help. That could not occur in a pandemic because
people would be in their hometowns looking after their
families, their community, in a way that would prohibit it.
We also learned, I think, that most emergency events, if
you will, like a hurricane or a bioterrorism event, are
constrained as to time. The event occurs and then we move into
recovery. That is not the case with a pandemic. It goes on for
more than a year in waves. So life has to go on, so our
preparation for a pandemic is different.
The Chairman. I am sorry to interrupt you.
Secretary Leavitt. No, that is fine. I would just say that
we are overdue, and we are not as well prepared as we need to
be. We are better prepared today than we were yesterday. We
will be better prepared tomorrow than we are today. It is a
continuum of preparedness.
No one knows whether this current virus will be the spark
of a pandemic. We do know that pandemics happen and that we
need to be better prepared. Everything we do on a pandemic
helps us become a safer and a healthier community. Whether it
is for a pandemic or whether it is a bioterrorism event, the
preparation essentially is the same.
The Chairman. Does that conclude your testimony?
Secretary Leavitt. That concludes my statement, yes.
The Chairman. Do you think local communities are taking
this seriously? I know you are and I know the Department is
because I have seen evidence of it everywhere on news shows and
reporting that is going on. But is this just sort of, well,
that is what happened in the bubonic plague era, not ours?
Secretary Leavitt. Well, I think we are clearly moving from
the buzz phase to the business phase. There are lots of
communities, many companies, many schools and colleges and
communities, and so forth, that are beginning to take action.
Regrettably, there are those who haven't yet, and that is where
we need to focus.
The thing about a pandemic and preparedness is that it
requires everyone to prepare. This isn't just something we can
delegate to our local government. Every business needs to have
a plan. Every college needs a plan, every school needs a plan.
Every day care center, every residential facility or long-term
care facility for the elderly needs a plan. Every hospital
needs a plan. Every family needs a plan. This is something on
which there is a shared responsibility throughout society.
The Chairman. Isn't it true that where we have had these
recent outbreaks in Indonesia just this week, and I believe
Romania where there have been deaths, there is literally human
handling of birds, specifically plucking the feathers, wringing
the necks and eviscerating them in a very hand-held fashion?
Secretary Leavitt. You are making an important point. I
have said if you are a bird, it is a pandemic. If you are a
human, it isn't. This is clearly a bird disease at this point.
The worry is that it will mutate, and there are steps of
progress that viruses make and one of those steps is to go from
bird to human, and then the next step is to go from human to
human, and the next step is to go from human to human in a
sustained and efficient way.
We have done a very good job in this country of sensitizing
people to the human-to-human worry. What we have not done as
good job in is making certain that we underline the words
``sustainable and efficient.'' We have seen human-to-human
transmission in a very inefficient and highly unusual way.
We saw it in Hong Kong in 1997. We have seen it in Thailand
last year, and now we have seen it, or at least there is some
suspicion we may be seeing it in this case in Indonesia. In
each of those cases, it can be found in an index case. The
first case generally started with a bird. What we are finding
in Indonesia is that there was, in fact, the index case of a
woman who was, in fact, handling birds and became sick in a way
very similar to that which others have.
The investigators have found that those who then later
contracted it were in very close proximity to a severely ill
woman, and they were sleeping in quarters that are described as
essentially a closet. While it has not been demonstrated, the
best hypothesis we have at this moment is that because of their
intimate and close contact with the highly sick patient, they
may have, in fact, contracted it as well. There is nothing
inconsistent about that over what we saw in Thailand or in Hong
Kong in 1997.
We continue to watch that very closely. I am happy to
report to you that we have some of the best scientists in the
world on this subject who are literally on the scene and who
are literally examining those people and doing the kind of
investigation that needs to be done.
The Chairman. Mr. Secretary, it probably needs to be said
as an assurance to the elderly who often tune in to this
hearing that there is a reason why we haven't had these
sporadic outbreaks in the United States, in Europe and the more
Westernized parts of Asia, and that is that the eviscerating
operations in this country run to very high sanitary and
mechanized kinds of procedures. I suspect you have seen the
turkey plants in Utah. I have seen the chicken ones in
Arkansas. It is amazing. It is not a business I would want to
be in, but it is very clean and sanitary.
Is it important to remind the American people what is being
done to protect the fowl and the consumption of bird products
in this country?
Secretary Leavitt. It is. It is important not only to
remember that, first of all, it is a bird disease, not a
broadly based human disease. Second of all, we have not seen an
H5N1-positive bird in the United States yet, and we have
certainly not seen it in a human being.
It would not be a big surprise to us to see a wild bird
with the virus on board, simply because they are wild and they
fly through natural flyways all over the world. When that
occurs, it will not be a crisis. It would not be a big surprise
at some point to see it in a domestic flock, but your point is
an important one. We manage those flocks with great care. The
Department of Agriculture has seen these kinds of high-
pathogenic viruses before. They know what to do.
Perhaps the final point that must be made is that poultry
when properly cooked is safe. Cooking kills the virus, and
there is not a reason for people to reduce, for example, their
consumption of poultry out of worry because of avian influenza.
The Chairman. One of the other concerns I have, Mr.
Secretary, really relates to where we are as a Nation in terms
of vaccines. As you know better than anyone, we don't do many
vaccines in this country anymore. We have literally litigated
them abroad.
Secretary Leavitt. Well, that may be among the most
important problems that our preparedness has brought focus to.
The good news is we believe there is the capacity to develop a
vaccine that could provide an immune response to this virus.
The bad news is we do not have the capacity domestically to
produce a sufficient supply for every person in the United
States to have a vaccine. That is part of what the President
has put forward, an ambitious effort to change that.
Some of that is because the vaccine business has become a
lousy business in our country. Over the last 25 years, most of
the vaccine manufacturers have gone out of business or have
discontinued that work. The Congress was, I think, insightful
in appropriating $3.3 billion. Two weeks ago, I spent $1
billion of it on vaccine manufacturing technology research that
is being done.
We have a plan that, within 3 to 5 years, we will change
that. Our ambition is to have the capacity to not only isolate
a virus, but then to be able to produce a sufficient supply of
vaccines for every person within the United States who chooses
to have one.
The Chairman. Within the United States?
Secretary Leavitt. Within the United States.
The Chairman. That is an important thing to achieve,
frankly, because if we actually had a pandemic and all the
manufacturers in Europe have the same problem, they are not
likely to want to send it here; they are going to use it there.
Secretary Leavitt. That is an important insight and one
that we acknowledge. Consequently, part of our criteria has
been to assure that any new manufacturing capacity that we
partner to develop is done domestically.
The Chairman. Senator Kohl.
Senator Kohl. Thank you.
Just to follow up a little bit more on that, Mr. Secretary,
what sense of urgency is there to develop our capacity for this
vaccine? You know, if it is coming on board 5 or 10 or 15 years
from now, then we are just having a nice conversation today.
Secretary Leavitt. When I first began focusing on this
problem, it appeared that, first of all, there was no
additional capacity coming online. Second of all, the plan to
get to what is known as cell-based technology, which is the big
hope in being able to manufacture it more quickly, appeared to
be somewhere between 8 and 10 years away.
I have met with all of the manufacturing organizations,
with NIH, with the scientists. The President has, as well, and
we have asked them to help us find every way possible to
accelerate the development of this technology, and for that
reason we are partnering and the $1 billion of contracts that I
released on May 4 are a very good and important indication of
that. The 3 to 5 years that I have spoken of is an ambitious,
and I might say very aggressive approach, and will have
substantially reduced the amount of time that it would have
taken had we not taken that action.
Senator Kohl. If we have a pandemic this year or next year,
is it fair to conclude that we will not have what we need to
have by way of vaccinations?
Secretary Leavitt. Let me go a step further than that,
Senator. Pandemics, as I indicated in my opening statement,
generally last about a year to a year-and-a-half, and they come
in waves of between 6 and 8 weeks. It takes about 6 months from
the time we have isolated the virus that caused the pandemic to
create a safe vaccine and to manufacture it.
Best case: What that tells me, and I am sure you, is that
during the first 6 months of a pandemic we will be without a
vaccine no matter what. The business of creating vaccines is
really about being able to have it for the second and the third
wave.
What you have stated is correct. We would not have
sufficient supply of vaccines for the first wave even after we
have been able to develop this capacity because you really
can't stockpile in large measure vaccines because the virus you
are ultimately going to be preparing the vaccine for may be
substantially different than the one that you have been
preparing for.
Now, we are stockpiling significant stockpiles of vaccines.
We have 8 million doses of the best of an isolate we created in
Vietnam. That would produce some level of immune response, but
it would be far from perfect and we are basically working as we
go. What that means it that when you start dealing with a
pandemic, you have got to have a comprehensive approach, and we
are working intensively right now to develop social distancing
and public health tools that communities can use in order to
limit or to contain viruses as they happen in their
communities.
Senator Kohl. You said that local communities to a large
extent will be on their own during a flu pandemic and shouldn't
expect a great deal of help from the Federal Government. What
assistance should State and local communities expect from the
Federal Government in the event of a pandemic?
Secretary Leavitt. Thank you, Senator. There is a very
important role for the Federal Government and we are going to
play it, but it is important to define it. An example of one of
our roles is the international monitoring that we have just
reflected with respect to Indonesia. We are building a network
of laboratory capacity and having personnel on the ground all
over the world so that if this begins to happen anywhere, we
have a knowledge of it at the earliest possible moment.
That gives us the capacity to respond and prepare. It also
would give us a head start or a jump start in the development
of vaccines, for example. So international monitoring and
national monitoring are a role that only the Federal Government
can play, and we will play it.
Vaccine development--again, it would be unreasonable that
any one community or a State, even, would develop a vaccine.
Therefore, the Federal Government has taken responsibility for
the development of vaccines, and we are making substantial
progress and I have reported partially on that.
The third area would be in the development of stockpiles of
anti-virals and other matters. Now, I have been very careful
and direct in telling the States that our stockpiles will be
insufficient to cover every community, but at least it gives
them a start on something that they can begin to build.
A fourth area in my mind is State and local preparedness.
We have begun to create checklists and to hold exercises and to
push hard for local communities to realize that they simply
cannot ignore this and expect that the State government or the
Federal Government overall will resolve it.
These checklists that I have--this is one on long-term care
facilities, for example. You mentioned that in your statement.
Those checklists and the exercises that we do reveal our
weaknesses. We can never be afraid to see our weaknesses
because that is how we get stronger, and that is one of the
roles of the Federal Government.
Another role that we are playing is to work on how to
communicate on this. This is a tough subject to deal with. The
problem is anything you say in advance of a pandemic seems
alarmist. On the other hand, everything you would do to get
ready for it when it starts is inadequate. So we are working to
teach State and local governments and businesses and schools
how to talk about this in ways that inform, but will not
inflame, and ways that will help people to prepare, but not to
panic. Those are all roles that the Federal Government can and
must play, and we are doing everything possible to assure we do
our responsibility well.
Senator Kohl. Earlier this week, the Washington Post
reported on a study at Baylor College of Medicine that shows
that people older than 65 may need as much as four times the
standard level of flu vaccine for effective protection. Are you
taking that into consideration as you build our stockpile of
flu vaccine?
Secretary Leavitt. That is a very important piece of
information and we are taking that very seriously, and it gives
me an opportunity really to talk about one of the side benefits
of all of this pandemic preparedness.
We have had inadequate annual flu vaccine for many years
now. Every year, we go through a period of are we going to have
enough, are we not going to have enough. We have had a lot of
producers offshore or out of the United States that have had
problems and it is an ongoing problem that we have to solve.
One of the benefits of creating new vaccine manufacturing
capacity is that we can take that annual flu vaccine problem
off the table forever because we will have to keep our pandemic
vaccine capacity warm, if you will, and the best way to use it
will be to make annual flu vaccine. That would give us now an
opportunity to say, rather than use a one-size-fits-all method
of application for the annual flu, we can begin to say, well,
perhaps we have got to look at seniors. Maybe they don't have a
similar immune response, and if that is the case, we will now
have flu vaccine that will allow us to provide it.
Senator Kohl. Thank you very much, Mr. Secretary.
The Chairman. Thank you, Mr. Secretary, for giving us
insight for all the contingencies and make the preparations.
Secretary Leavitt. Thank you, Senator.
[The prepared statement of Secretary Leavitt follows:]
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[Recess.]
The Chairman. Thank you for your patience, ladies and
gentlemen.
Let me first begin with an introduction of our panel. We
will first hear from Dr. Steve Cline. He is the Chief of
Epidemiology for the State of North Carolina and he is
overseeing the State's pandemic flu preparation efforts. He
will discuss the work which States like North Carolina are
beginning to undertake with the new pandemic influenza
preparedness funding that Congress recently appropriated,
specifically highlighting plans for outreach to the elderly
community.
Then we will hear from Nancy Donegan. She is the director
of Infection Control for the Washington Hospital Center. She is
here today speaking on behalf of the American Hospital
Association. The Washington Hospital Center was one of the
primary facilities involved in the 2001 anthrax scare, so they
have had firsthand experience in responding to a community-wide
emergency event. Her facility has developed a communicable
disease response plan and she will discuss the specific issues
it addresses.
We appreciate your both being with us today. Shall we go
ladies first?
STATEMENT OF NANCY DONEGAN, DIRECTOR OF INFECTION CONTROL,
WASHINGTON HOSPITAL CENTER, WASHINGTON, DC; ON BEHALF OF THE
AMERICAN HOSPITAL ASSOCIATION
Ms. Donegan. Good morning. I am Nancy Donegan, the director
of Infection Control at the Washington Hospital Center, a 900-
bed, Level I trauma center which is part of the MedStar Health
Corporation. On behalf of the American Hospital Association's
4,800 members, I appreciate this opportunity to appear before
you today.
Pandemic influenza is one of many possible emergencies that
hospitals face. Hospitals maintain all-hazards plans for
responding to a range of events, from natural disasters, to
terrorist attacks, to pandemic outbreaks. Today, my testimony
will highlight three issues: the capacity demands of pandemic
influenza, the pandemic plan at the Washington Hospital Center,
and AHA's recommendations for the Federal Government's role
related to hospital preparedness.
To prepare for emerging infectious diseases like avian
influenza, hospitals must be ready to care for a large
increase, or surge, in the numbers of acutely ill patients over
a prolonged period of time. Surge capacity involves increasing
hospital staffing and resources needed for patient care.
Hospitals can increase their patient care capacity for
relatively short periods of time by surging in place; that is,
rapidly discharging appropriate patients, canceling elective
procedures and increasing the number of staff. While surging in
place can temporarily increase patient capacity, most hospitals
will be overwhelmed if an event involves large numbers of ill
over a prolonged period of time, such as in a pandemic, as
supplies and staff are depleted. At the same time, hospitals
will need to continue providing routine acute care, such as
treating traumatic injuries and attacks and delivering babies.
Over the last 5 years, hospitals receiving funds through
the National Bioterrorism Hospital Preparedness Program have
improved readiness. To date, hospitals have received about $2
billion. However, there is still a significant gap in
readiness. In a sustained disaster such as a pandemic,
hospitals would rapidly face a shortage of personnel and
critical supplies such as ventilators, gloves, masks, gowns and
drugs. The New York Times has reported that the national supply
of ventilators, which would be critical for caring for patients
in an influenza pandemic, falls far short of the estimated
need.
The Center for Biosecurity at the University of Pittsburgh
Medical Center has estimated that the minimum cost of realistic
readiness for a severe 1918-like pandemic are at least $1
million for an average size hospital. We believe that to have
adequately prepared hospitals, a portion of Federal pandemic
funding should be directly applicable to hospitals.
The pandemic plan at the Washington Hospital Center follows
the three pillars of the National Implementation Plan: one,
preparedness and communication; two, surveillance and
detection; three, response and containment. Our plan employs
both high- and low-tech methods to communicate important just-
in-time messages to staff and physicians. We have developed
computerized and paper-based tools for reporting cases to the
public health department and to hospital clinical areas.
During a pandemic, all entry points into the hospital will
need to screen patients based on epidemiologic definitions
provided by the CDC. Hospitals will also need to screen all
workers on a regular basis during a pandemic episode. In our
plan, we have detailed methods to have workers self-monitor and
self-report symptoms of respiratory infection.
The best clinical response would include the use of
effective vaccine or anti-viral therapy. Without effective
vaccination, prophylaxis and therapy, infection control
measures are the only strategies left to prevent transmission
in the hospital.
Infection control measures rely on patient isolation and
personal protective equipment, along with engineering controls.
The hospital has designed ER One, the Nation's first all-risks-
ready scalable emergency facility to handle mass-casualty
events, including the ability to handle contagious patients.
The AHA supports the Federal Government's efforts to
increase the stockpile of anti-viral drugs, increase research
on non-egg vaccine production, and develop a prototype vaccine
for avian influenza. In addition, an allocation plan for anti-
viral drugs and vaccines must recognize the importance of
hospital staff, physicians and emergency personnel.
In conclusion, the National Pandemic Influenza
Implementation Plan states, preparation requires infrastructure
and capacity, a process that can take years. Hospitals do not
have the means to create infrastructure or capacity with
current funding. If the Nation is to be protected, hospitals
will look to the Federal Government for greater resources to
meet the anticipated burden.
Mr. Chairman, thank you for the opportunity to testify. I
look forward to answering any questions.
[The prepared statement of Ms. Donegan follows:]
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The Chairman. Thank you, Nancy, and we will have questions.
Steve, take it away.
STATEMENT OF J. STEVEN CLINE, DDS, MPH, CHIEF, EPIDEMIOLOGY
SECTION, DIVISION OF PUBLIC HEALTH, NORTH CAROLINA DEPARTMENT
OF HEALTH AND HUMAN SERVICES, RALEIGH, NC
Dr. Cline. Thank you, Mr. Chairman and distinguished
members of the Senate Special Committee on Aging. I am honored
to be testifying here today before you on behalf of public
health and the 8.7 million citizens of North Carolina, 2.4 of
whom are over the age of 50, representing 28 percent of our
population. In the next couple of decades, we expect that to
increase to 35 percent of the North Carolina population over
the age of 50.
I am proud to be here. When I was explaining to my family
that I was doing that, children have a way of keeping you
humble. They said, why are you speaking to the Committee on
Aging? Oh, Dad, it is because you are old. [Laughter.]
Preparing for and responding to an influenza pandemic will
be a monumental task that will affect all of us, young and old.
The National Influenza Response Plan and the National Influenza
Implementation Plan you heard Secretary Leavitt speak of places
much of the responsibility to appropriately planning,
preparing, detecting and responding on our Nation's State and
local health departments. Our citizens have expectations that
we will get that right.
This sense of urgency is further heightened by the amount
of media attention pandemic flu is getting. We see daily death
counts of human cases of bird flu as they move from Southeast
Asia across Europe, and certainly on its way to the U.S.
We have TV movies dramatizing fictional pandemics in this
country, and newspaper stories almost daily, some saying we are
not ready, some saying there is more transmission happening
human-to-human, as in yesterday's article. Of course, as we
have already alluded to, we all watched the devastation of
Katrina on the Gulf Coast and wonder is our community ready for
such a big disaster.
In my comments today, I would like to focus on three
things: the progress that we have made in the area of
preparedness; second, the challenges that we still face; and,
third, how can Congress help keep us making progress.
First, in the area of accomplishments, let me say thank you
to Congress for the substantial Federal investment you have
made in public health preparedness. States like North Carolina
have done much to get ready, and as Secretary Leavitt said, we
are much better prepared today than we were yesterday and we
hope we will be better prepared tomorrow. I will mention
briefly just some of our accomplishments in North Carolina and
would be happy to answer questions about them following the
testimony.
As you heard, all emergencies start locally, so we have
invested a substantial amount of money in our State in local
public health preparedness in all 100 counties, in all 85
health departments serving those counties. We have built a
health alert network system, a secure system for notifying our
key partners when an emergency occurs.
We have increased our capacity in our State Laboratory of
Public Health, which will be a critical component to
identifying, isolating and understanding the infection. We have
built a hospital emergency department surveillance system that
connects all 113 hospital emergency departments in North
Carolina and reports every 12 hours to the State Health
Department.
We have built public health regional strike teams and based
them across the State so that they can respond wherever it
emerges. We have built State medical assistance teams, which is
a three-tiered system for scaling up medical surge capacity in
our State. We have created public health epidemiologists in
hospitals, borrowing from the concept of embedded journalists
in the Iraq War, and put public health people inside hospitals,
which has helped tremendously. We have also improved our
interoperable communications, and training, training, training.
In the area specifically of pandemic flu response, we have
a very robust plan in North Carolina, the North Carolina
Pandemic Flu Response Plan, first written in October 2004 and
revised substantially this year. We have a broad-based pandemic
flu planning committee which makes sure we are taking into
account all of the citizens of North Carolina. In particular,
we have a special populations work group that can focus on the
unique needs of elderly, disabled, home-bound and other
minority groups, particularly those who have English as a
second language. We are developing a tool kit building upon the
checklists that our Federal Government has and making those
specific to North Carolina.
There are challenges that are unique to being an older
American and I would like to highlight just a couple of those.
Older Americans, we have already acknowledged, are one of the
fastest-growing segments of our population. They often have
fragile health, which requires more services, not fewer. More
services during a pandemic may create a problem.
We are worried about reaching the non-institutionalized
older adults. How do we find them? How do we know they are
safe? How do we know they are healthy? We are working closely
with community-based organizations who often are best at
reaching those people, but will they be available and able to
help us during an emergency? We have heard some discussion this
morning already about the annual flu vaccine and the importance
of providing good annual flu vaccine to all Americans,
particularly our elderly.
Where do we go from here? I have already mentioned the
importance of funding. Sustained funding is the key component
for us to continue making progress in preparedness.
The second is to improve our adult immunizations. We heard
Secretary Leavitt speak about hopefully improving the vaccine
production system. That is important, but it is also important
to improve the demand for that vaccine. Our people need to show
up for those vaccines. Only about 48 percent of adults in our
State get the annual flu vaccine. Also, the infrastructure to
provide those vaccines needs to be improved. Vaccine
production, we have already heard about.
Communications is another important component. The
communications are tricky in a normal day. In a crisis and in
an emergency, they will be even trickier. We will need strong
leadership and clear messages if we hope to reach the public
with the important information that they are going to need.
In closing, I would like to say responding quickly and
effectively to a pandemic flu will require extraordinary
measures, in an atmosphere of fear, chaos and human tragedy. A
strong, well-supported public health system is critical to
saving lives and managing the crisis. The investments that have
been made must continue if we expect to serve our citizens
well.
Thank you. I would be happy to answer questions.
[The prepared statement of Dr. Cline follows:]
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The Chairman. Thank you, Steve. Forty percent of adults or
seniors show up for flu shots in North Carolina?
Dr. Cline. No. Forty-eight percent in North Carolina get
the annual flu vaccine.
The Chairman. What if the other 52 percent showed up? Would
you have it?
Dr. Cline. It is often an issue of timing and mal-
distribution, not that we haven't had enough vaccine. We have
had seasons when we did not have enough vaccine, but most
recently the vaccine arrived late. People think about getting
their vaccine in October, November, December. January and
February, which is still part of the annual season--often, that
is not on their mind anymore and they don't show up for those
vaccines.
The Chairman. Is it for want of information, or is part of
it some choose not to have it?
Dr. Cline. I think some choose not to have it. I bet we
have all heard of people who say I am worried the flu vaccine
is going to give me the flu, which is false. Let me go on the
record saying that.
The Chairman. That is why I asked the question. I want to
get that out. It is false.
Dr. Cline. But also I think people think if it is a vaccine
toward the end of the season, it is not going to help them that
season. That is also false. Flu can occur all year. In fact, we
have flu all year, and whatever immunity you develop to that
virus that year may help you, in fact, in any other flu virus
attack.
The Chairman. Steve, since this is the Committee on Aging,
what is your State, and what should other States be doing to
have some coordination with nursing homes and assisted living
or people living independently, but who are still needy?
Dr. Cline. We have built something in our State called--the
acronym is SMART, but it is the State Medical Assets Tracking
System. What it does is allow us to know exactly how to contact
every long-term facility, hospital, group home in our State
that is licensed. We are able to put that in a geographic
information system so we can map it. They are part of an
electronic communications system so that we can easily
communicate with them. Hopefully, working with them to develop
their own facility plans, there will be a way for us to get
good information to those residents.
The Chairman. You are getting information to them to have a
plan in case of an epidemic?
Dr. Cline. Yes. I would say probably the most important
thing we are doing now, and I would suggest we should all be
about, is engaging that group, that population, the facility
employees, directors, staff, as well as the public.
Dr. Cline. Do you also have a relationship with area
agencies on aging and with faith-based organizations that have
their own networks?
Dr. Cline. We do. We work with them at the State level and
their State representatives, but our real work is getting our
local public health departments to work, and know those and
build those relationships locally.
The Chairman. Well, that is very commendable.
Nancy, I wonder if Washington Hospital Center and other
MedStar facilities have staff vaccination policies; in other
words, getting the people who are working there and taking them
coming in--how do you keep them healthy?
Ms. Donegan. We do have a policy and we encourage flu
vaccine very actively. It is not adequate that some of these
biases and feelings that people have about flu vaccine have
continued through time, despite, I would say, increasing
campaigns to reach our health care workers to get a better
vaccinated staff.
Recently, the guidelines for influenza for next year
introduced a new issue that encourages us to have declination
statements from health care workers who refuse the vaccine.
Although it hasn't been implemented yet, I think it is a very
good strategy as the bridge to probably some time when we will
have mandatory vaccine for our workers.
We hope that when there is a face-to-face decision with
some face-to-face counseling rather than posters and education
campaigns that people will make that choice. We approach the
campaign with a little bit of information focused on protecting
the employee, but I think we focus more and have our greater
success when we focus on the patients they are talking of and
their obligation to not be a conduit to expose their most
vulnerable patients, and probably most effectively that, being
in the public exposure, we want them to protect their babies at
home and their elderly at home. That seems to be our greatest
take right now, now that it is voluntary.
The other thing that we are doing with that in preparation
for pandemic flu is that we are trying to increase the
dedication to vaccine that everyone in the hospital recognizes
is their obligation, so that as we sometimes fall on a bad
year, whether it is avian influenza or just a very bad non-
avian influenza, we already will have the infrastructure; that
this is a hospital where our workers get vaccinated. So the
last couple of years, we are really trying to promote that with
a much more aggressive stance.
The Chairman. You mentioned in your testimony the need for
Federal dollars coming directly to hospitals for these
preparations. That is not happening now?
Ms. Donegan. No. It seems as though most of the funding
goes to public health and that we appeal to public health for
distribution to hospitals, so that hospitals are really quite
independent in their problem-solving, although they look to
public health for reinforcement.
The Chairman. Are public health agencies not sympathetic to
hospitals?
Dr. Cline. I would like to answer that. She is correct. The
HRSA funding for hospital preparedness comes to public health,
and we think at least in our State that is a very good way to
do it because we are actually able to work at a State level and
coordinate all of the needs--hospitals, emergency medical
services, homeland security grant dollars and public health
dollars--and then apply it where it is appropriate.
The Chairman. But if you see the need, you are going to be
there. She is saying the need is there, or at least it could
be. Are you sensitive to that, Steve?
Dr. Cline. Well, all of that money is going out to
hospitals, correct, yes.
The Chairman. I know we are spending a lot of money. It
just seems like there is never enough, but that is true in
almost any category of the appropriations that goes on here.
Senator Kohl is in charge of appropriations, so we will look to
him to figure out how to get the right amounts.
The question I have, Nancy, is as to partnerships that
Washington Hospital may have with other medical facilities in
the area. Are there regulatory issues that are an impediment to
using one another's backups or anything you need us to be aware
of that we should----
Ms. Donegan. No. I think that the hospital community has
worked together one institution with the other quite well
through time. We refer to each other, we refer to each other's
services, and many of our workers work in multiple
institutions.
Clearly, after September 11 and after the anthrax attacks,
that communication linkage became much more formalized. There
are networks that are very formalized, and even some of the
smallest threats that--you know, in this area, sometimes we
have worries that will come up and we quickly go into a network
kind of methodology where we have communication and reinforce
that communication.
Our hospital, the Washington Hospital Center, is part of a
corporation, so we have a linkage with the corporation that is
very formalized, and then one that is somewhat formalized with
other hospitals in the region so that we have sharing.
Our biggest problem, despite our sharing--our sharing is
really more on the communication level, but in our area, and I
think in many areas, we really have all of our beds full
everyday. We have patients in our hallways. So the idea that we
could take more patients from another location--we aren't able
to do it, nor are we able to send our patients to another
facility. They are full, too.
So the idea of surge capacity, I think, is limited. We have
limited success in that, in that we can do sort of an immediate
response. But once we have filled those beds and once we need
to maintain an ever-increasing population of patients, we
really max out and we run out of structure, and there isn't a
sister institution that can pick up our burden. We really sort
of max out through the system.
The Chairman. Just one last question. Are there any
protocols existing between post-9/11 and Katrina from lessons
learned there that would help all the medical facilities in
this area? If there were actually someone who came down with
avian flu here, is there a facility identified as the best one
to take that individual, someone with a contagion of that
nature?
Ms. Donegan. I don't know everyone's readiness. Our
hospital does work very much to be able to stand behind the
statement that we are all-risk-ready. Clearly, we have quite
elaborate plans for a pandemic, and we had those plans
beginning before 9/11. We clearly ramped them up after anthrax
and the idea of bioterrorism, and I think our greatest educator
so far has been SARS, especially what happened with Toronto and
their experience. We really used that as our model for
readiness.
So we would say we are very ready, but I suspect from
talking to people in other hospitals that each hospital has
amplified their readiness significantly. I don't know if it is
to the same degree as we have. Partly because of our location
and partly because of our sort of unique make-up, I think we
are really dedicated to this issue. But I think most hospitals
have changed their point of view on this and have much more
accelerated degrees of readiness than they had.
The Chairman. Well, I am not even suggesting that the
policy implicit in my question is a good one. I don't know.
Steve, should there be a facility designated or not, or
should each one be prepared to deal with it on their own?
Dr. Cline. I think each one has to be prepared to deal with
it on their own, and I think if we look at the smallpox
experience when we were planning how we would deal with
smallpox, no hospital wanted to stand up and say, OK, I will be
the smallpox hospital. It really didn't make sense until you
knew more about where it was emerging and how it was happening.
I think the best readiness is going to be to make sure each
hospital has a plan and that all hospitals are talking to each
other and public health, and we will make a good decision when
that happens.
The Chairman. Senator Kohl.
Senator Kohl. It seems as though it would be a reasonable
conclusion that, depending upon individuals such as yourselves
all across this country, some communities are far more advanced
in making preparations. Would it be reasonable to assume that
other communities of equal size would be far less advanced?
Because it is apparently being handled as a situation that
needs to be dealt with on a State-to-State and local-to-local
basis, would you estimate that to be the case?
Ms. Donegan. I would suspect there is some variability. For
the most part, the efforts that you take in preparing for
these, there are not special teams; no one gets hired to be the
pandemic coordinator. The efforts come from taking busy people
in busy jobs and sort of peeling off a new layer of
responsibility. So I would imagine there is significant
variability in the amount that different institutions have been
able to do and that it is quite a task, but I don't know the
measurement of that variability.
Dr. Cline. I would agree there is not really a good
measurement of it. North Carolina is an urban and rural State,
so we have small communities that we know are not as well
prepared as some other parts of the State. What we are doing to
compensate for that is to build some regional capacity that we
hope can move into that area if it happens and while we are
still working trying to get every community ready.
Senator Kohl. In the event of a flu pandemic, isn't it
essential that we have sufficient quantities of vaccination,
without which most other preparations are going to be totally
inadequate? Is that a fair conclusion?
Dr. Cline. Well, I think we are preparing for the reality
that for the first wave of the flu there will not be a vaccine
that is highly effective. But after that, we are hoping that
there will be a vaccine and there will be some control measures
that our citizens have gotten used to. Vaccination is one of
the marvels of modern medicine in terms of preventing disease.
We certainly want to get there as fast as we can, but with the
flu virus, which changes regularly, we are going to have to
wait until it emerges and then develop the vaccine.
Senator Kohl. How long does that take? In your judgment,
how long will that take?
Dr. Cline. Well, I think Secretary Leavitt said 6 months. I
think the annual cycle is closer to 9 months for when they
develop and can manufacture enough to get it out to all the
providers. As you heard, they are making efforts to reduce that
cycle to where it is a shorter time, and if we can move to the
newer cellular technology--right now, they use eggs for
developing that vaccine--we hope that will shorten that time.
Senator Kohl. Well, does this mean that if a flu pandemic
breaks out, we are defenseless for several months?
Dr. Cline. I will let you answer, but it does mean that
infection control is going to be the important factor.
Senator Kohl. Is that right, Ms. Donegan?
Ms. Donegan. That is exactly right. The SARS experience
really is our best model for teaching us not only that
hospitals can put in good practices without therapy and without
vaccine, but that infection control can work. However,
infection control efforts are very difficult to maintain
because they are behavior-based and they are barrier-based. In
a complicated hospital setting where the technology and the
acuity of the patients demands sort of a focus on patient care,
some of the burden of using masks and goggles and gowns--it is
very hard to have personnel do that with the reliability that
they need to do to make this a fail-safe plan.
So with a vaccine, you can really protect the employee
while they are doing their typical activities. Otherwise, you
are left with this infection control behavior that is difficult
and has an element to fatigue to it. The workers in Toronto
needed quite a bit of reinforcement because of the fatigue
factor from really doing infection control strategies
completely. Clearly, as they do more work on a respiratory
track--when they sort of do a more high-risk procedure, then we
need to provide even more barrier for them to protect them
during those procedures.
So those elements work, but they need reinforcement, they
need a lot of equipment. They really need us to protect our
employees for issues like the fatigue factor and that we have a
good stream of material for them.
Dr. Cline. I do think SARS was a success story for
containment without treatments and vaccines in this country,
but it was much smaller scale. North Carolina had one of only
eight laboratory-confirmed cases of SARS in the United States.
It involved three of our hospitals. At the time, we thought it
was only being transmitted in the health care setting. So it
was not in the community. Pandemic flu will be very different
because it will be in the community and our public will be
asking how do I protect myself and my family. Some of the
extreme measures of mask and gown and barrier protection are
not going to be available, or maybe not even effective in the
community.
Senator Kohl. What do you imagine will happen if the flu
pandemic breaks out and communities all across our country know
that it is here and about, but we don't have a vaccine? What is
going to be the individual reactions of families and entire
communities? You have probably thought about that. What do you
think?
Dr. Cline. We have thought about that and we have also
asked our public what is their likely response. What we get is
they will self-isolate. They will figure out how to take care
of themselves and their family in their homes as much as
possible for as long as possible to try to avoid being in a
place that they are worried could transmit the flu.
Senator Kohl. Does that mean they won't go to work and
won't send their kids to school, just go out maybe to buy
essentials at the store and go back home?
Dr. Cline. Exactly, exactly.
Senator Kohl. Is that what is likely to happen across our
country?
Ms. Donegan. I think that is the view that we share, yes.
Senator Kohl. You can imagine a situation where the entire
country virtually shuts down if it is a truly national
pandemic, a flu pandemic, because there is no vaccination
available and the hope is isolation so that you are not
contaminated. The only way you can do that is by staying
isolated, meaning you don't go to work and the kids don't go to
school. All the meetings that are scheduled are called off. Is
that right?
Ms. Donegan. I think so. I think the dim view is how much
economic and social impact this will have by behaviors like you
are talking about. Then the more rosy view I think we also
learned from SARS is that we saw this adaptability of a
population where they met many of their responsibilities in
life. They put on masks and they kept their social distancing.
Humans in large degree are adaptive, and so I don't know to
what extent--clearly, I would think there would be the extent
that we are talking about with this enormous impact and
dysfunction. Then I would imagine that we would also see
examples of resiliency and some return with adaptation that
comes on a personal level, is my view on that.
Dr. Cline. Yes, I agree with her. Obviously, though, if we
all self-isolated, there are some things about our way of life
that would stop and that we not really prepared to do. There is
some critical infrastructure and critical business that gets
done in this country that we really can't afford for all of
them to stay home.
So we are beginning that dialog in North Carolina to say
where do you draw that line. Has every business taken a look at
what they need to do to maintain just the bare minimum of their
work going and develop a plan for that? We are trying to help
them with that and coordinate that so that those critical needs
of food and power and shelter can continue.
Senator Kohl. Thank you. Thank you, Mr. Chairman.
The Chairman. Thank you, Senator Kohl.
Nancy and Steve, we are grateful for your presence here
today and your patience with the interruption of the roll call
vote. You have contributed greatly to our understanding and we
salute your preparations.
With that, we are adjourned.
[Whereupon, at 11:33 a.m., the Committee was adjourned.]
A P P E N D I X
----------
Prepared Statement of Senator Hillary Rodham Clinton
Thank you, Chairman Smith and Senator Kohl, for calling
this hearing today, and bringing attention to the issues of the
elderly population in pandemic situations.
In many of our discussions around pandemic influenza, we
have been looking back at the events of 1918, when young,
healthy individuals bore the brunt of illness and death.
But when you consider the other pandemics of the 20th
century--those that occurred in 1957 and 1969--the elderly were
among those that were hardest hit by the virus.
The pattern in the 1957 and 1969 pandemics mirrored those
that we see every year during our seasonal flu epidemic, when
we have over 36,000 deaths and more than 200,000
hospitalizations that are concentrated among elderly
individuals, who are at greater risk of complications from the
flu.
As such, I think that we need to increase our preparedness
for the special needs of senior citizens to ensure that they
will be able to continue to access necessary medical and
support services without interruption.
But what is particularly worrisome to me, when thinking
about our nation's ability to help seniors get the vaccines and
antivirals that will help them survive a pandemic, is the fact
that we aren't even prepared to deal with the seasonal
influenza epidemic that we face--that we know with certainty
that we will face every single year.
Since 2000, we have had multiple shortages of seasonal flu
vaccine. We all recall senior citizens lining up for hours to
obtain flu vaccine, unscrupulous distributors attempting to
sell scarce vaccine to the highest bidder, and millions of
Americans delaying or deferring necessary flu shots.
Because we don't have a system through which to track
vaccine, we can't ensure the supplies that we do have reach the
highest priority populations--including seniors and the
chronically ill--who should get vaccinated as early as possible
in any given flu season.
I've introduced legislation with Senator Pat Roberts, the
Influenza Vaccine Security Act, that would help us make some
positive changes in our nation's system for distributing,
tracking and delivering seasonal flu vaccine.
Our legislation would establish a tracking system through
which we could better trace the distribution of vaccine from
the factory to the provider and identify counties with high
numbers of priority populations, including senior citizens.
With such a system in place, we could easily determine in
times of shortage where vaccine was most needed and facilitate
distribution to those areas to help our elderly get the shots
that they need. All of this could take place in a matter of
hours, rather than days or weeks.
It simply makes sense to establish an operational tracking
system for vaccine distribution that can be used in both
seasonal and pandemic events, rather than rely on untried
mechanisms in an emergency situation where we will already be
facing multiple obstacles to delivery of health care--in
particular, life saving care for elderly populations.
I look forward to working my colleagues on this committee
to continue to raise awareness of the needs of senior citizens
in pandemic and other emergency situations. Thank you.
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