Jeffrey P. Koplan, M.D., M.P.H.

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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 11^th have been defining moments for all of us--and they have greatly sharpened the Nation=s focus on public health. Even before the September 11^th 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 11^th 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 11^th 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 11^th, 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.