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Tommy G. Thompson
U.S. Department of Health and Human Services
Topic: Bioterrorism Preparedness
Before the Subcommittee on Labor, Health and
Human Services, Education, and Related Agencies
Committee on Appropriations
United States Senate
October 3, 2001
Mr. Chairman and Members of the Subcommittee, thank you for inviting me here today
to discuss the Department of Health and Human Services (HHS) preparedness to respond to acts
of terrorism involving biological agents.
Among weapons of mass destruction, bioterrorism features several characteristics that set
it apart from other acts of terrorism involving, for example, explosives or chemical agents.
While explosions or chemical attacks cause immediate and visible casualties, an intentional
release of a biological weapon would unfold over the course of days or weeks, culminating
potentially in a major epidemic. Until sufficient numbers of people arrive in emergency rooms,
doctors' offices and health clinics with similar illnesses, there may be no sign that a bioterrorist
attack has taken place.
Three important points must be considered in bioterrorism preparations. First, biological
agents are easy to conceal. A small amount may be sufficient to harm large populations and
cause epidemics over a broad geographic region. Second, the contagious nature of some
infectious diseases means that once persons are exposed and infected they can continue to spread
the disease to others. Third, in the most worrisome scenario of a surreptitious attack, the first
responders are likely to be health professionals in emergency rooms, physician offices, outpatient
clinics, public health settings, and other health-care activities rather than the traditional first
responders. The longer the terrorist-induced epidemic goes unrecognized and undiagnosed, the
longer the delay in initiating treatment and other control efforts to prevent further infectious
The broad goals of a national response to bioterrorism, or any epidemic involving a large
population will be to detect the problem, control the epidemic's spread and treat the victims.
HHS's approach to this challenge has been to strengthen public health infrastructure to deal more
effectively with epidemics and other emergencies, and to hone our emergency health and medical
response capacities at the federal, state and local level. HHS has also worked to forge new
partnerships with organizations related to national security.
What has HHS been doing to prepare for this kind of event? Our efforts are focused on
improving the nation's public health surveillance network to quickly detect and identify the
biological agent that has been released; strengthening the capacities for medical response,
especially at the local level; expanding the stockpile of pharmaceuticals for use if needed;
expanding research on disease agents that might be released; developing new and more rapid
methods for identifying biological agents and improved treatments and vaccines; improving
information and communications systems; and preventing bioterrorism by regulation of the
shipment of hazardous biological agents or toxins.
Several HHS agencies play a key role in our preparedness for terrorist events, including
the Office of Emergency Preparedness (OEP), the Centers for Disease Control and Prevention
(CDC), the Food and Drug Administration (FDA), and the National Institutes for Health (NIH).
In order to advance an orderly and comprehensive approach to the many issues involved
in such preparation, in July of this year I appointed a special assistant within the Immediate
Office of the Secretary to lead the Department's bioterrorism initiative. I have directed this
individual, Dr. Scott Lillibridge, to begin creating a unified HHS preparedness and response
system to deal with these important issues. Under my direction, Dr. Lillibridge will provide
executive leadership and organizational direction for HHS budget, policy, and program
implementation on terrorism preparedness issues. Let me assure you that this is a top priority for
me and for my entire Department.
We are striving at HHS to strengthen our readiness and response, and our ability to
respond has been greatly improved over the last several years. The system is not perfect,
however, and we must continue to accelerate our preparedness efforts.
Improved Surveillance is Key to Detection
If a terrorist used a biological or chemical weapon against the civilian population, how
quickly the outbreak is detected, analyzed, understood and addressed would be the responsibility
of state and local public health jurisdictions and the Centers for Disease Control and Prevention.
The 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 and
within CDC itself related to bioterrorism. CDC has established a Bioterrorism Preparedness and
Response Program within its National Center for Infectious Diseases to direct and coordinate
their 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, the agency has awarded more than $130 million in cooperative
agreements to 50 states, one territory and four major metropolitan health departments to support,
- Preparedness planning and readiness assessment;
- Epidemiology and surveillance;
- Laboratory capacity for biological or chemical agents; and
- The Health Alert Network (a nationwide, integrated, electronic communications
The CDC has launched an effort to improve public 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 sole responsibility of providing
rapid and accurate triage and subsequent analysis of biological agents suspected of being terrorist
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
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
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.
Because food may be a likely medium for spreading infectious diseases, FDA as well as
CDC have enhanced their surveillance activities with respect to diseases caused by foodborne
pathogens. 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.
Bioterrorism Preparedness and Response
HHS coordinates and provides health leadership to the National Disaster Medical System
(NDMS), which is a partnership that brings together HHS, DOD, FEMA, and the Department of
Veterans Affairs (VA). The NDMS provides medical response, patient evacuation, and
definitive medical care for mass casualty events. This system addresses both disaster situations
and military contingencies. More than 7,000 private citizens across the country volunteer their
time and expertise as members of response teams to support this effort. This system also
includes approximately 2,000 participating non-federal hospitals. VA and DOD's expertise and
resources are critical to many key aspects of NDMS response, and I would note that these
Departments have distinguished themselves on many occasions.
In most localized disasters, including the scurrilous attacks on the World Trade
Centers in New York and the Pentagon here in Washington, HHS organizes its medical field
response through the Office of Emergency Preparedness using a team structure. Teams can
include Disaster Medical Assistance Teams, specialty medical teams (such as burn and
pediatric), and Disaster Mortuary Teams. In addition, National Medical Response Teams are
able to deploy to sites anywhere in the country with a supply of specialized pharmaceuticals to
treat up to 5,000 patients. Currently, HHS can draw on 27 such teams that can be federalized and
deployed to assist victims. Such teams have been sent to many areas in the aftermath of disasters
in support of FEMA-coordinated relief activities.
HHS, through OEP, has the capability to mobilize NDMS resources, the Public Health
Service's Commissioned Corps Readiness Force, as well as enlist the support of other federal
agencies, such as DOD and VA, to help provide needed medical and public health services to
treat disaster victims. In the last few years, these assets were deployed to New York, Florida,
Texas, Louisiana, Alabama, Mississippi, the Virgin Islands and Puerto Rico in the aftermath of
hurricanes and tropical storms, and to New York and Virginia in response to the events of
September 11, 2001.
However, regional or national response to a health emergency involving bioterrorism will
also require that additional capacities be in place at the state and local level before the disaster
strikes. HHS, primarily through CDC, is supporting state and local governments to strengthen
their surveillance, epidemiological investigation and laboratory detection capabilities, as well as
continuing development of a national stockpile of critical pharmaceuticals and vaccines to
supplement local and state resources.
The Office of Emergency Preparedness is working on a number of fronts to assist local
hospitals and medical practitioners to deal with the effects of bioterrorism and other terrorist acts.
Since Fiscal Year 1995, for example, 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 will has contracted with 97 municipalities to develop MMRSs. The FY 2002 budget
includes funding for an additional 25 MMRSs (for a total of 122).
MMRS contracts require the development of local capability for mass
immunization/prophylaxis for the first 24 hours following an identified disease outbreak;
distribution of 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.
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. 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 Program's (OJP) National
Domestic Preparedness Consortium and we will continue our excellent relationship with them.
OJP and HHS have teamed together to develop a healthcare 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.
In conclusion, the Department of Health and Human Services is committed to ensuring
the health and medical care of our citizens. We have made substantial progress to date in
enhancing the nation's capability to respond to a bioterrorist event. And, Mr. Chairman, the
Department is prepared to respond! But there is more we can do - - and must do - - to strengthen
the response. Priorities include strengthening our local and state public health surveillance
capacity, continuing to enhance the National Pharmaceutical Stockpile, and helping our local
hospitals and medical professionals better prepare for responding to a bioterrorist attack. Our
mission is to accelerate these efforts.
Mr. Chairman, that concludes my prepared remarks. I would be pleased to answer any
questions you or members of the Subcommittee may have.
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Last revised: October 3, 2001