the Committee on Energy and Commerce
States House of Representatives
Bioterrorism Preparedness: CDC's Role in Public Health
of Health and Human Services
Release on Delivery
Thursday, November 15, 2001
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
terrorist events of September 11th 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 11th
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
11th, 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.
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.
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.
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
11th, President Bush has requested an additional
$1.5 billion to strengthen our ability to prevent and
respond to bioterrorism.
me outline several areas of this budget request that specifically
relate to the work performed by CDC.
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.
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.
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
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
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.
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.
Communications, and Training
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.
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
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
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.
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.
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.
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.
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.
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.
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.
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.
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, 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.
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.
this time, I would be happy to answer questions from you
and Members of the Committee.