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Federal
Efforts to Coordinate and Prepare for Bioterrorism:
The HHS Role
Statement
of
Tommy
G. Thompson
Secretary,
Department
of Health and Human Services
Wednesday, October 17, 2001
Mr. Chairman and Members of the Committee, thank you for inviting
me here today to discuss the Department of Health and Human
Services (HHS) role in federal government efforts to coordinate,
prepare for and respond to acts of terrorism, particularly those
involving biological or chemical agents.
The Federal Emergency Management Agency (FEMA), as overall
lead federal agency for consequence management efforts, has
designated the Department of Health and Human Services (HHS) as
the lead agency to coordinate medical assistance in national
emergencies, be they natural disasters or acts of terrorism.
When FEMA determines a federal response is warranted, this
agency deploys medical personnel, equipment, and drugs to assist
victims of a major disaster, emergency, or terrorist attack.
Given our critical medical role in any biological,
chemical, radiological or nuclear attack, I take HHS preparedness
efforts most seriously.
We are working very closely within the Administration to
make sure our resource needs are adequately and accurately
developed. Areas we
have particularly focused on include:
Accelerating development and procurement of vaccines and
pharmaceuticals to control and treat critical biological threats,
including smallpox and anthrax.
Protecting our food supply by increasing inspections of
food imports, and providing the Food and Drug Administration (FDA)
more of the modern equipment needed to detect select agents.
Working with cities to ensure that their Metropolitan
Medical Response System units have the equipment and training to
respond to bioterrorist events and other disasters.
Working with States to ensure they have comprehensive
response plans, and increasing their capacity to detect and
respond to threats. This
includes:
expanding the number of State labs with rapid testing
capability;
improving coordination with local response plans, and
expanding the Health Alert Network.
Implementing a new hospital preparedness effort to ensure
that our health facilities plan for the equipment and training to
respond to mass casualty incidents.
Recent events involving anthrax have highlighted the
collaboration between state and local health and law enforcement
officials, HHS’s Centers for Disease Control and Prevention (CDC)
and the Federal Bureau of Investigation (FBI).
We are continuing to conduct investigations related to
anthrax exposures in Florida, New York, Nevada, and our Nation’s
Capitol complex. CDC
and state and local health officials continue to work closely with
medical professionals nationwide to monitor hospitals and
out‑patient clinics for any possible additional anthrax
cases. During this
heightened surveillance, cases of illness that may reasonably
resemble symptoms of anthrax will be thoroughly reviewed until
anthrax can be ruled out.
The public health and medical community continue to be on a
heightened level of disease monitoring.
This is an example of the disease monitoring system in
action, and that system is working.
Coordinated Preparedness Efforts
As you know, much of the initial burden and responsibility for
providing an effective response by medical and public health
professionals to a terrorist attack rests with local governments.
If the disease outbreak reaches any significant magnitude,
however, local and state resources will be overwhelmed and the
federal government will be required to provide protective and
responsive measures for the affected populations.
HHS agencies that play a key role in our Department’s
overall terrorism preparedness include the CDC, the FDA, the
Office of Emergency Preparedness (OEP), and the National
Institutes of Health (NIH).
The Department has always valued the cooperation that it
has received from its federal, state, and local government
partners. We work
closely with all of the agency signatories of the Federal Response
Plan and have had a particularly close working relationship with
FEMA, the Department of Defense (DOD), the Department of Justice
(DOJ), the Department of State (DOS), the Department of Veterans
Affairs (VA), the U.S. Department of Agriculture (USDA), the
Department of Energy (DOE), and the Environmental Protection
Agency (EPA).
I will focus the remainder of my testimony on a few
examples of HHS’s terrorism preparedness efforts conducted in
collaboration with our federal, state, and local partners.
National Disaster Medical System
The National Disaster Medical System (NDMS) is the vehicle for
providing resources for meeting the medical, mental health, and
forensic service requirements in response to major emergencies,
federally declared disasters, and terrorist acts.
Begun in 1984, NDMS is a
partnership among HHS, VA, DoD, FEMA, state and local
governments, and the private sector.
The System has three components: direct medical care;
patient evacuation; and the non‑federal hospital bed system.
NDMS was created as a nationwide medical response system to
supplement state and local medical resources during disasters and
emergencies, to provide back‑up medical support to the
military and VA health care systems during an overseas
conventional conflict, and to promote development of
community‑based disaster medical systems.
The availability of beds in over 2,000 civilian hospitals
is coordinated by VA and DoD Federal Coordinating Centers.
The NDMS medical response component is
comprised of over 7,000 private sector medical and support
personnel organized into approximately 70 Disaster Medical
Assistance Teams, Disaster Mortuary Operational Response Teams,
and speciality teams across the Nation.
When there is a disaster, FEMA, as the Nation’s
consequence management and response coordinator, tasks HHS to
provide critical services, such as health and medical care;
preventive health services; mental health care; veterinary
services; mortuary activities; and any other public health or
medical service that may be needed in the affected area.
HHS’s Office of Emergency Preparedness directs NDMS, the
Public Health Service’s Commissioned Corps Readiness Force, and
other federal resources, to assist in providing the needed
services to ensure the continued health and well being of disaster
victims.
Pharmaceutical Stockpiles
The VA is one of the largest purchasers of pharmaceuticals
and medical supplies in the world.
Capitalizing on this buying power,
OEP and VA have entered into an agreement under which the
VA manages and stores specialized pharmaceutical caches for
OEP’s National Medical Response Teams. The VA has purchased many of the items in the pharmaceutical
stockpile. The VA is
also responsible for maintaining the inventory, ensuring its
security, and rotating the stock to ensure that the caches are
ready for deployment with the specialized National Medical
Response Teams. Additionally,
during FY 2001, OEP provided funds to the VA to begin to develop
plans and curricula to train NDMS hospital personnel to respond to
weapons of mass destruction events.
Research Efforts
With the support of Congress, the President has implemented
a government‑wide emergency response package to help deal
with the tragic events of September 11th.
This complements efforts already underway to prepare our
nation against such heinous attacks, including threats of
bioterrorism. For
example, CDC and the National Institutes of Health (NIH) within
HHS are collaborating with the Department of Defense (DOD) 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 substantial degree on the state of relevant medical science.
In some cases, new vaccines, antitoxins, or innovative drug
treatments need to be developed or stocked.
Moreover, we need to learn more about the pathogenesis and
epidemiology of the infectious diseases which do not affect the
U.S. population currently. We
have only limited knowledge about how artificial methods of
dispersion may affect the infection rate, virulence, or impact of
these biological agents.
Our continuing research agenda in collaboration with CDC,
NIH, and DOD is vital to overall preparedness.
Even before the events of September
11, HHS’s Food and Drug Administration
actively cooperated with DOD in the operation of its
vaccine development program and the maintenance of their stockpile
program. Any vaccine
development, whether by DOD or private industry, must be in
accordance with FDA requirements that ensure the safety,
effectiveness and manufacturing quality of the finished product.
FDA provides assistance to DOD regarding the research
required to develop new vaccines, as well as assistance during all
phases of development.
FDA also works with DOD’s office that screens new and
unusual ideas for development of products to treat diseases and
develop diagnostic tools.
Food Safety
Because food is a possible medium for spreading infectious
diseases, FDA and CDC are enhancing their surveillance activities
with respect to diseases caused by foodborne pathogens, and are
working with our federal, state, and local partners to coordinate
these activities. PulseNet,
a national network of public health laboratories created,
administered and coordinated by CDC in collaboration with FDA and
USDA, enables the comparison of bacteria isolated from patients
from widespread locations, from foods and from food production
facilities. This type
of rapid comparison allows public health officials to connect what
may appear to be unrelated clusters of illnesses, thus
facilitating the identification of the source of an outbreak
caused by intentional or unintentional contamination of foods.
FDA also works with the EPA, the Nuclear Regulatory
Commission and other agencies to address chemical and nuclear food
safety issues of concern.
Training
HHS has used classroom training, distance learning, and
hands‑on training activities to prepare the health and
medical community for contingencies such as bioterrorism and other
terrorism events. For
example, in Fiscal Year 1999, Congress appropriated funds for OEP
to renovate and modernize the Noble Army Hospital at Ft.
McClellan, Alabama, so the hospital can be used to train doctors,
nurses, paramedics and emergency medical technicians to recognize
and treat patients with chemical exposures and other public health
emergencies. Working
with CDC and the VA, a training program was developed for
pharmacists working with distribution of the National
Pharmaceutical Stockpile. Expansion
of the bioterrorism component of Noble Training Center curriculum
is a high priority for HHS.
HHS has been working closely with the Office of Justice
Programs (OJP) National
Domestic Preparedness Consortium, and we will continue our
excellent relationship with them.
OJP and HHS have teamed together to develop a health care
assessment tool and have also delivered a combined MMRS/first
responder training program.
CDC has participated with DOD, most notably to provide
distance‑based learning for bioterrorism and disease
awareness to the clinical community.
CDC is now moving to expand such training with
organizations, such as the Infectious Disease Society of America (IDSA),
and Schools of Public Health, such as the Johns Hopkins Center for
Civilian Biodefense.
The recent FEMA‑CDC initiative to expand the scope of
FEMA’s Integrated Emergency Management Course (IEMC) will serve
as a vehicle to integrate the emergency management and health
community response efforts in a way that has not been possible in
the past. It is
clear that these communities can best respond together if they are
able to train together toward realistic scenarios that leverage
the best of both organizations.
Because the initial detection of a biological terrorist
attack will most likely occur at the local level, it is essential
to educate and train members of the medical community – both
public and private – who may be the first to examine and treat
the victims. It is
also necessary to upgrade the surveillance systems of state and
local health departments, as well as within healthcare facilities
such as hospitals, which will be relied upon to spot unusual
patterns of disease occurrence and to identify any additional
cases of illness. HHS
and its other partners will continue to provide terrorism-related
training to epidemiologists and laboratorians, emergency
responders, emergency department personnel and other front-line
health-care providers, and health and safety personnel.
State and Local Collaborations
HHS has also had a particularly close working relationship with
local and state public health and health care delivery
communities. We
coordinate closely with the public safety, public health, and
health care delivery communities at all of these levels,
particularly through the health agencies and emergency management
authorities.
As key partners in our response strategy, state and local
public health programs comprise the foundation of an effective
national strategy for preparedness and emergency response.
Preparedness must incorporate not only the immediate
responses to threats such as biological terrorism, it also
encompasses the broader components of public health infrastructure
which provide the foundation for immediate and effective emergency
responses.
CDC has used funds provided by the past several Congresses
to begin the process of improving the expertise, facilities and
procedures of state and local health departments to respond to
biological terrorism. For
example, over the last three years, the agency has awarded more
than $130 million in cooperative agreements to 50 states, one
territory and four major metropolitan health departments as part
of its overall Bioterrorism Preparedness and Response Program.
CDC has invested $90 million in the Health Alert Network
(HAN), a nationwide system that is now in all 50 states, which
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.
The CDC also has launched an effort to improve public
health laboratories. 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 biological
agents is available in an emergency event.
Metropolitan Medical Response System
HHS is also working on a number of fronts to assist local hospitals
and medical practitioners to deal with the effects of biological,
chemical, and other terrorist acts.
Since Fiscal Year 1995, for example, HHS through OEP has
been developing local Metropolitan Medical Response Systems (MMRS). Through contractual relationships, the MMRS uses existing
emergency response systems – emergency management, medical and
mental health providers, public health departments, law
enforcement, fire departments, EMS and the National Guard – to
provide an integrated, unified response to a mass casualty event.
As of September 30, 2001, OEP has contracted with 97
municipalities to develop MMRSs.
During FY 2002, we intend to award $10 million to 25
additional cities (for a total of 122) through the MMRS to help
them improve their medical response capabilities.
MMRS contracts require the development of local capability
for mass immunization/prophylaxis for the first 24 hours following
an identified disease outbreak; the capability to distribute
materiel deployed to the local site from the National
Pharmaceutical Stockpile; local capability for mass patient care,
including procedures to augment existing care facilities; local
medical staff trained to recognize disease symptoms so that they
can initiate treatment; and local capability to manage the remains
of the deceased.
Conclusion
The Department of Health and Human Services is committed to working
with other federal agencies as well as state and local public
health partners to ensure the health and medical well‑being
of our citizens. The
mutual and ongoing consultation, assistance, collaborations and
support HHS receives from its federal agency partners are useful
in identifying not only programmatic overlaps but also gaps in our
preparedness efforts. These
efforts also allow us to work toward integrating our respective
initiatives into a government‑wide framework.
Our ongoing relationships with state and local governments
have been reinforced in recent years as a result of the
investments we have made in bioterrorism preparedness.
Without their engagement in this undertaking, we would not
be seeing the advances that have been made in recent years.
We have made substantial progress to date in enhancing the
nation’s capability to respond to biological or chemical acts of
terrorism. But there
is more we can do to strengthen the response.
Priorities include strengthening our local and state public
health surveillance capacity, continuing to enhance the National
Pharmaceutical Stockpile, improving public health planning and
preparedness at the state and local level, and helping our local
hospitals and medical professionals better prepare for responding
to a biological or chemical terrorist attack.
Mr. Chairman, that concludes my prepared remarks.
I would be pleased to answer any questions you or members
of the Committee may have.
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