Testimony
Before the Committee on Energy and Commerce
United States House of Representatives

HHS Bioterrorism Preparedness: CDC's Role in Public Health Protection

Statement of
Tommy G. Thompson
Secretary
Department of Health and Human Services

For Release on Delivery
Expected at 10:00am
on Thursday, November 15, 2001

 

Good morning Mr. Chairman and Members of the Committee. Thank you for the invitation to discuss my Department's role in protecting our nation's public health and bioterrorism. I am accompanied today by Dr. Jeffrey P. Koplan, Director of the Centers for Disease Control and Prevention (CDC), and Dr. D.A. Henderson, the head of our newly created Office of Public Health Preparedness, which will coordinate the Department-wide respond to public health emergencies. Before I begin, I would like to compliment this Committee for its foresight in working to enact "The Public Health Threats and Emergencies" bill last year, which was a landmark piece of legislation supporting improvements to our nation's public health infrastructure. Through your hard work and dedication, much of the infrastructure and tools to increase the public health capacity to address bioterrorism and other public health emergencies is already in place. Thank you.

The terrorist events of September 11^th and later events related to anthrax have been defining moments for all of us - and they have greatly sharpened the Nation's focus on public health. Prior to the September 11^th attack on the United States, CDC had made substantial progress in defining and developing a nationwide framework to increase the capacities of public health agencies at all levels -- federal, state, and local. Since September 11^th, CDC has dramatically increased its level of preparedness and is developing and implementing plans to increase it even further. In recent weeks, I have spent considerable time at CDC--and President Bush, Homeland Security Director Ridge and myself also visited the CDC last week--witnessing first hand the efforts to address the health threats this Nation currently faces and to prepare for future needs to protect the Nation's health.

I know some critics are charging that our public health system is not prepared to respond to a major bioterrorist attack. I know that some state and local labs are feeling overwhelmed right now, but the response from state and local authorities--to each and every threat--is continuing and will continue. And we should be proud of how well we have all responded to events that have broken our hearts even as they have steeled our resolve.

Just a month ago, for example, our best information told us that inhalation anthrax was 80 percent fatal. We never want to see fatalities, and it truly is a tragedy that four people have died. But the fatality rate for inhalation anthrax in these attacks has been 40 percent - and I am happy to report today that the last patient hospitalized is now at home with his family. It's a testament to the CDC's expertise that we have been able to save lives, prevent countless people from becoming ill and treat those who have fallen ill. And it's a testament to the CDC and public health professionals that people with inhalation anthrax are walking out of the hospital. While our response has been strong, we must - and we will - do more. The response to anthrax attacks is an evolving science, one that is being rewritten with each passing day.

The Department of Health and Human Services plays a vital role in protecting our homeland from a bioterrorist attack, and an even more important role in responding to the health consequences of such an attack. In the aftermath of September 11^th, President Bush has requested an additional $1.5 billion to strengthen our ability to prevent and respond to bioterrorism.

Let me outline several areas of this budget request that specifically relate to the work performed by CDC.

Funding Initiatives

• National Pharmaceutical Stockpile

The President's request includes $643 million to expand the National Pharmaceutical Stockpile, which is managed by CDC. With these resources, HHS will expand its program capabilities to respond to an all-hazards event.

As you may know, there are currently 8 Push Packs available as part of the Stockpile. Each one includes no less than 84 separate types of supplies; things like antibiotics, needles and I-Vs, a tablet counting machine and nerve agent antidotes. Each Push Pack provides a full course of antibiotics and other medical supplies and is shipped to an area within 12 hours to help state and local response efforts. These Push Packs are complemented by large quantities of pharmaceuticals stored in manufacturers' warehouses. This is called Vendor Managed Inventory (VMI). The VMI and the 8 Push Packs combined have enough drugs to treat 2 million persons for inhalation anthrax following exposure.

I have directed that the Stockpile should be increased for anthrax so that 12 million persons can be treated. CDC will reach that level of response during Fiscal Year 2002. With the additional resources, we will also add four more Push Packs to the current eight already located across the country, making more emergency supplies available and augmenting our existing supplies of 400 tons by another 200 tons.

• Research

The Administration is also committed to the development and approval of new vaccines and therapies. The CDC, the Food and Drug Administration and the National Institutes of Health - all agencies within HHS - are collaborating with the Defense Department and other agencies to support and encourage research to address scientific issues related to bioterrorism.

The capability to detect and counter bioterrorism depends to a significant degree on the state of relevant medical science. This continuing collaborative research agenda of CDC, FDA, NIH, and DOD is critical to overall preparedness.

• Laboratory Capability

The President is calling for an expansion of HHS's capacity to respond to bioterrorist incidents, including $20 million for the CDC's Rapid Response and Advance Technology and specialty labs, which provide quick identification of suspected agents and technical assistance to state labs. We're also providing $15 million to support increased capacity in no less than 78 laboratories in 45 states. This funding will enhance our ability to identify and detect critical biological agents.

• Surveillance, Communications, and Training

Also included in this amount is $20 million to support additional expert epidemiology teams that can be sent to states and cities to help them respond quickly to infectious disease outbreaks and other public health risks. And let me reiterate my conviction that every state should have at least one federally funded epidemiologist who has been trained in the CDC's Epidemic Intelligence Service (EIS) training program. The President's budget will accomplish this goal. Currently, there are 42 EIS officers in 24 States.

The President is also requesting $40 million to support the nation's Public Health communications infrastructure to facilitate information sharing concerning potential bioterrorism agents, which includes Web-based disease notification systems to the health community nationwide. This amount will provide for the expansion of the Health Alert Network, which will assist CDC in disseminating critical, time-sensitive disease alerts to 75 percent of the nation's 3,000 counties, and Epi-X, a secure web-based communications system that provides information sharing capabilities to state and local health officials. These expansions will encourage state and local health departments to be vigilant in identifying public health threats. I intend to have all counties connected in the coming year. One of our goals is to assist state and local health departments achieve 24/7 capacity to receive and act upon health alerts. And we're providing $10 million to augment state and local preparedness by providing training and resources for state health departments to develop readiness plans on bioterrorism and emergency response.

• Food Safety

The President is also requesting $61 million to enhance the frequency and quality of imported food inspections and modernize the import data system to enable us to detect tainted food. This funding will also provide for 410 new FDA inspectors to help ensure that our food is better protected.

• Security for CDC Facilities

The Administration is also requesting an additional $30 million to enhance the security of CDC and other critical facilities operated by the Department. Members of this Committee have expressed concern about the overall security of the nation's laboratories, and I share their concerns. There has been - and needs to be - a great deal of focus on the critical need for additional resources to heighten security at CDC facilities. I have read a 1996 HHS Inspector General report that recommended security at facilities be increased, and a recent review of those findings. Progress has been made, but the Department must do better.

Included in the amount requested by the President is $8 million for needs that can be addressed immediately at our CDC campuses, and $22 million for crucial upgrades that will harden security at these facilities that house some of the country's most dangerous pathogens. These investments are important to our public health mission and our fight against bioterrorism, and I implore you to fund this request.

Legislative Initiatives

In legislation the President sent to Congress to strengthen the Department's ability to respond to bioterrorism, much of the new authority requested lies in the area of food safety. I am particularly concerned about this issue.

As I have mentioned, too few resources have in the past been dedicated to food safety. But it is not just a matter of money. The Department-FDA-has for years needed enhanced authority to stop potentially deadly food supplies from entering into commercial channels.

Currently, the FDA cannot require that the owner of food hold further distribution of that product into the stream of commerce until a product's safety can be determined. In a public health emergency, FDA needs the authority to detain food for a reasonable time so that it can assess the hazard and not worry that goods are entering into commercial channels. In the case of certain public health emergencies, this limited new authority would be vital to protecting the American public.

Also included in the Administration's proposal is increased maintenance and inspection of source and distribution records for foods. Under current law, if the FDA suspected food was being used in a biological attack, the Agency could not access the records of food manufacturers, packers, distributors and others to identify the location of a product or the source of that product. Such records might not even be maintained. Requiring that records be kept, and that FDA have the authority to inspect and copy these records is not unreasonable in light of the serious health consequences that could occur if our food supply became a vehicle for bioterrorism.

The President has also requested that the FDA be able to prevent importers who have a history of repeated violations of our food safety laws from continuing to import food into this country. And, the Administration has asked that food importers give advanced notice that their shipments are approaching our borders, so that FDA will have time to gather information that it needs to make quick, informed decisions about whether to allow entry into this country.

Also requested by the Administration are additional tools to improve the security and safety of the many private laboratories throughout this country that handle potentially deadly pathogens. The possession, use and transfer of biological agents and toxins by these facilities is an issue that concerns many not only in the public health community, but also in the intelligence and defense communities. Under the proposal, the Department would have the authority to regulate entities handling these pathogens.

This Committee and the full House of Representatives, have already recognized the importance of this issue, by passing legislation that addresses this issue. Thank you, Mr. Chairman, and members of this Committee, for swiftly moving the President's proposal.

Conclusion

In conclusion, the Department's top priority is to protect the Nation's health. To do this, the Department, through the CDC, continues to focus on building a solid public health infrastructure-with our state and local partners--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.

Regardless of the arsenal, the Department of Health and Human Services is helping to build core public health capacities in this country that will allow us to more effectively respond to any public health emergency in the future.

At this time, I would be happy to answer questions from you and Members of the Committee.