Testimony
Before the Committee
on Appropriations, Subcommittee on Labor, HHS, Education
and Related Agencies
United
States Senate
CDC's
Public Health
Response to Bioterrorism
Statement of
Jeffrey
P. Koplan, M.D., M.P.H.
Director
Centers
for Disease Control and Prevention
Department
of Health and Human Services
For Release on Delivery
Expected at 9:00 am
on Thursday, November 29, 2001
Good morning, Mr. Chairman
and Members of the Subcommittee. I am pleased to appear
before you on behalf of the Centers for Disease Control
and Prevention (CDC). Thank you for the invitation to
discuss CDC=s
public health response to the threat of bioterrorism.
The terrorist events on
and since September 11th have been defining
moments for all of us--and they have greatly sharpened
the Nation=s
focus on public health. Even before the September 11th
attack on the United States, CDC was making substantial
progress to define, develop, and implement a nationwide
public health response network to increase the capacity
of public health officials at all levels--local, state,
and federal--to prepare for and respond to deliberate
attacks on the health of our citizens. Since September
11th we have dramatically increased our efforts,
resulting in a heightened level of preparedness, which
we are committed to increase even further based on lessons
learned in recent months.
CDC's top priority is to
protect the Nation's health. To do this, CDC focuses on
building a solid public health infrastructure - at CDC,
as well as at the state and local level to protect the
health of all citizens. As recent events have shown so
dramatically, we must be constantly vigilant to protect
our nation's health and security. The war on terrorism
is being fought on many fronts, and we must ensure a strong,
robust public health system to be on guard at all times
to prevent and respond to multiple and simultaneous terrorist
acts. The arsenal of terrorism may include biological,
chemical, and radiological agents as well as conventional
and non-conventional weapons, as the attack on the World
Trade Center so vividly attests.
Bioterrorism
Preparedness
CDC has used funds provided
by Congress to begin the process of improving the expertise,
facilities and procedures of state and local health departments
and within CDC itself related to bioterrorism. CDC has
established a Bioterrorism Preparedness and Response Program
to direct and coordinate our activities. CDC has a dedicated
anti-bioterrorism staff of more than 100 full-time professionals
comprising expertise in epidemiology, surveillance, and
laboratory diagnostics.
Over the last three years,
we have awarded more than $130 million in cooperative
agreements to 50 states, one territory and four major
metropolitan health departments to support,
(1) Preparedness planning
and readiness assessment;
(2) Epidemiology and surveillance
(3) Laboratory capacity
for biological or chemical agents; and
(4) The Health Alert Network
(a nationwide, integrated, electronic communications system).
Since September 11, we
have sent almost 500 CDC staff to the field. For Example,
at the height of the anthrax response in the Nation's
Capital, there were 85 staff in Washington, DC alone.
These experts included epidemiologists, industrial hygienists
involved in environmental sampling and clean up, laboratorians,
communications specialist to assist with media relations,
and logistics and management staff. CDC not only investigated
cases that proved to be anthrax in four states and the
District of Columbia, but also investigated suspicious
cases in six other states. These cases proved not to be
anthrax, but required CDC assistance to go through the
process of ruling them out. CDC experts were needed to
augment the staff of state and local health departments,
who would have been severely overtaxed without our help.
The Administration has requested $20 million through the
Emergency Response Fund to create additional specialized
Federal teams and place additional Epidemic Intelligence
Service (EIS) officers in more States.
CDC has launched an effort
to improve health laboratories that likely would be called
upon to identify a biological or chemical attack. 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 rare and lethal biological agents is
available in an emergency event. The LRN also includes
the Rapid Response and Advanced Technology Laboratory
at CDC, which has the responsibility of providing rapid
and accurate triage and subsequent analysis of biological
agents suspected of being terrorist weapons. The Administration
has requested $35 million under the Emergency Response
Fund to improve state and local health departments' laboratory
capacity and improve CDC's internal laboratory capacity.
The CDC is also working
to provide coordinated communications in the public health
system, between federal agencies and between public health
officials and the public itself. To this end, CDC has
the Epidemic Information Exchange (EPI-X). The
EPI-X is a secure, Web-based communications network
that will strengthen bioterrorism preparedness efforts
by facilitating the sharing of preliminary information
about disease outbreaks and other health events among
officials across jurisdictions and provide experience
in the use of a secure communication system.
CDC has invested $90 million
in the Health Alert Network (HAN), a nationwide system
that will distribute health advisories, prevention guidelines,
distance learning, national disease surveillance information,
laboratory findings and other information relevant to
state and local readiness for handling disease outbreaks.
HAN 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. With the addition of several recent
awards, CDC has provided HAN funding and technical assistance
to 50 state health agencies, Guam, the District of Columbia,
three metropolitan health departments and three exemplar
Centers for Public Health Preparedness. The Administration
has requested an additional $40 million through the Emergency
Response Fund to improve and expand these systems.
CDC also manages the National
Pharmaceutical Stockpile (NPS), which provides us with
the ability to rapidly respond to a domestic biological
or chemical terrorist event with antibiotics, antidotes,
vaccines and medical materiel to help save lives and prevent
further spread of disease resulting from the terrorist
threat agent. The NPS Program provides an initial, broad-based
response within 12 hours of the federal authorization
to deploy, followed by a prompt and more targeted response
as dictated by the specific nature of the biological or
chemical agent that is used. The first emergency deployment
of the NPS occurred in response to the tragedy in New
York City.
We saw just how critical
local planning is - each state and community needs to
plan for terrorism. The planning process builds essential
relationships among public health, emergency management,
and health care providers. And this coordination, especially
with law enforcement must be strong - at the federal,
state, and local level - as the anthrax investigations
have highlighted. Currently, CDC funds only nine states
and two cities to do this planning. Under the Administration's
Emergency Response Fund request, an additional $10 million
will allow all states and territories to receive funding
for planning and preparedness activities.
In light of the recent
terrorist attacks, it is important for CDC to improve
security in its facilities. CDC received an additional
$3 million in the initial Administration release of Emergency
Response Funds, and the Administration's Emergency Response
Fund request also includes an additional $30 million to
secure CDC facilities, particularly where special pathogens
may be stored. Also, as mentioned earlier, there is an
additional $20 million to improve and upgrade CDC's internal
laboratory capacity.
Challenges
for the Future
Although we have accomplished a great deal in the past
10 weeks, we have several remaining challenges .
First, it is critical that we bolster infrastructure in
state and local health departments. As evidenced by our
experiences following the September 11th and
anthrax incidents, public health departments are at the
frontlines of emergency response. State and local health
departments need expanded capacities and resources for
key preparedness and response functions such as early
detection, laboratory analysis, and crisis communications.
In addition, we must continue
to forge relationships between clinical care and public
health. It was through the efforts of clinicians that
we were able to identify the cases of anthrax. These physicians
reported the cases to their local public health authorities
and obtained laboratory specimens for analysis at state
laboratories and CDC. The closer the relationship between
clinical medicine and public health the faster we are
able to identify potential bioterrorist threats and other
outbreaks, identify the cause of the illness, and provide
early treatment to save lives.
Another important opportunity
is to strengthen our relationships with other federal
agencies, and state and local agencies outside the field
of public health. Since September 11th, we
have created stronger partnerships with a wide range of
agencies, particularly the law enforcement community.
For example, in response to the recent events, CDC assigned
an individual to work at the FBI to assure optimal information
exchange between the two agencies. As we prepare for any
future threats, we need to maintain and enhance our ties
with a much larger range of agencies.
Finally, we must redouble
our efforts to enhance our own capacity at CDC to respond
to future threats. For example CDC has tested over 5400
human and environmental samples since October 4, our labs
have worked around the clock, with scientist sleeping
in their offices to avoid losing time. We need to expand
our scientific capacity in the areas of epidemiology,
surveillance, and laboratory, as well as accelerating
our plans to improve our physical facilities and enhance
security in all CDC locations.
Conclusion
In conclusion, CDC is committed
to working with other federal agencies as well as state
and local public health partners to ensure the health
and medical care of our citizens. We have made substantial
progress to date in enhancing the nation's capability
to prepare for and respond to public health threats and
emergencies, including bioterrorism events. The best public
health strategy to protect civilians against any health
threat is the development, organization, and enhancement
of public health systems and tools. Priorities include
a fully staffed, fully trained, and properly protected
public health workforce, strengthened public health laboratory
capacity, increased surveillance and epidemiological capacity,
secure up-to-date information systems, solid health communications
capabilities - all supported by flexible policies and
preparedness plans that enable the public health system
to prepare for and respond to any type of health emergency
at the federal, state, and local level. Not only will
this approach ensure that we are prepared for deliberate
bioterrorism threats, but it will also ensure that we
will be able to recognize and control any threat to the
public's health. A strong and flexible public health infrastructure
is our best defense. The Administration's Emergency Response
Fund request is an important step in this process and
we encourage you to support it.
At this time, I would be
happy to answer questions from you and Members of the
Committee.
HHS Home (www.hhs.gov) |
Topics (www.hhs.gov/SiteMap.html) |
What's New (www.hhs.gov/about/index.html#topiclist) |
For Kids (www.hhs.gov/kids/) |
FAQs (answers.hhs.gov) |
Site Info (www.hhs.gov/SiteMap.html) |
Disclaimers (www.hhs.gov/Disclaimer.html) |
Privacy Notice (www.hhs.gov/Privacy.html) |
FOIA (www.hhs.gov/foia/) |
Accessibility (www.hhs.gov/Accessibility.html) |
Contact Us (www.hhs.gov/ContactUs.html)
Last
revised: November 30, 2001