Before the Committee
on Government Reform, Subcommittee on National Security,
Veterans Affairs and International Relations
Communication: National Security and Public Health --The
Satcher, M.D., Ph.D.
Public Health Service
of Health and Human Services
For Release on
at 10:00 am
Thursday, November 29, 2001
Good morning, Mr. Chairman
and Distinguished Members of the Subcommittee:
I am Dr. David Satcher,
U.S. Surgeon General, and I appreciate this invitation
to speak with you about the public health response to
the threat of bioterrorism, specifically the Department
of Health and Human Services' (HHS) role in information
dissemination and risk communication. These have been
issues of growing concern among those of us in public
health and I am pleased to have this opportunity to discuss
them with you today.
The terrorist events on
and since September 11th and the bioterrorist
activities that began in the first week of October have
been defining moments for all of us. Both as a nation
and as public health officials, we have been taken to
a place where we have not been before. It was uncertain
what we were dealing with and to what extent; we had very
little science or past experience to draw upon; and we
literally learned more every day. The Nation's focus on
issues related to public health has been greatly sharpened.
There has been fear, shock, confusion, and - in some cases
- even panic.
While we may have encountered
some bumps in the road initially, it is actually quite
remarkable how well-coordinated our efforts have been.
The challenge was great. We were faced with the task of
coordinating communications among local governments, state
governments and the federal government. Each level came
with its own set of elected officials and public health
officials, all with their own concerns. HHS dealt with
it by being forthcoming. We informed the public quickly.
We let them know what we knew and when we knew it. When
the information changed because we learned something new,
we let them know it. Through it all, vital public health
information has been disseminated promptly and we have
delivered medicine to people who needed it.
As a result, while five
people too many have lost their lives, we have saved countless
other lives. Casualties were kept far below expectations,
in that the fatality rate for inhalation anthrax was thought
to be around 80 percent. The fatality rate in these attacks
has been about 40 percent. All of this demonstrates why
effective communication based on a strong and flexible
public health infrastructure is critical.
the Public Health Infrastructure
of a Plan for Bioterrorism
The Centers for Disease
Control and Prevention (CDC), as HHS's lead agency for
bioterrorism response, has developed a strategic plan
for addressing bioterrorism. That plan has five basic
components: preparedness and prevention, a surveillance
and early detection, diagnosis and characterization of
chemical agents, response and communication. Each component
integrates training and research.
A strong and flexible public
health infrastructure has within it the ability to carry
out the components of that plan. Under the leadership
of Secretary Tommy Thompson, HHS has been working to strengthen
the overall public health infrastructure so that we are
prepared to respond to a range of disasters and emergencies,
including bioterrorism. Since September 11th
we have intensified our efforts, resulting in a heightened
level of preparedness, and we are committed to further
increasing our preparedness based on lessons learned in
HHS and the
Public Health Service
This well-prepared and well-rehearsed
public health infrastructure must consist of several interrelated
components at various levels. Communication within and
among each level is critical, as is the need for mutual
The federal component is
within the Department of Health and Human Services. The
Centers for Disease Control and Prevention is the lead
agency for bioterrorism response and is closely allied
with the Office of Emergency Preparedness. Recently, the
Office of Public Health Preparedness was added by Secretary
Thompson to respond to bioterrorist attacks.
Also within HHS is the National
Institutes of Health (NIH), which focuses on research
to facilitate development of new drugs and diagnostic
agents and effective antitoxins and vaccines to fight
bioterrorism. NIH works in tandem with the Food and Drug
Administration (FDA), which has oversight of pharmaceutical
and vaccine approval and must ensure their safety and
efficacy. Also critical is the Health Resources and Services
Administration (HRSA), which is responsible for ensuring
access to that the poor and underserved have access to
health care services. This is a critical component considering
how much we depend on the public to respond early to unusual
occurrences. Finally, the Agency for Healthcare, Research,
and Quality is responsible for monitoring the quality
of care provided.
My role as Surgeon General
has included oversight of the Commissioned Corps of the
Public Health Service. The Commissioned Corps is one of
the federal government's seven uniformed services and
comprises 5,600 health professionals, including physicians,
pharmacists, nurses, dentists, dietitians, therapists,
veterinarians, and others involved in health services.
Commissioned Corps members are highly-trained and mobile
health professionals who carry out programs to promote
the health of the Nation, understand and prevent disease
and injury, assure safe and effective drugs and medical
devices, deliver health services to Federal beneficiaries,
and furnish health expertise in time of war or other national
or international emergencies. They are on call 24 hours
a day, 7 days a week.
The Surgeon General is also
responsible for communicating directly with the American
people based on the best available science. To date, most
communications with the Surgeon General have been based
on topics for which there has been extensive research
and investigation. While the role of the Surgeon General
in communicating in response to bioterrorism has never
been clearly defined, I can assure you that the Office
of the Surgeon General has been directly and substantially
involved in public communications related to the anthrax
Between October 4 and November
14, 2001, I participated in roughly 40 TV programs, interviews,
HHS and White House media briefings, and other press outreach
events on the subject of the anthrax mailings. At the
direct request of Secretary Thompson, I also made Deputy
Surgeon General Kenneth Moritsugu available to act as
a full-time liaison between HHS and Capitol Hill on the
anthrax situation. Dr. Moritsugu took part in numerous
briefings of Congress as well as Congressional and White
House press briefings. He also represented HHS at a Town
Hall Meeting with D.C. Del. Eleanor Holmes Norton, and
appeared alongside Rep. Shays at a similar meeting that
was televised live on WJLA-TV in Washington.
Internally, HHS faced challenges
with fluidity of information and the geographic divide.
We had staff in the field in the affected states, as well
as in offices in Atlanta, Bethesda, and Washington. The
Secretary instituted daily conference calls with all involved
offices to make sure everyone had the latest information.
The Department of Health
and Human Services works closely with state and local
health departments. The challenge maintaining communications
increases, considering that local health departments vary
widely in their size and scope. Some do not even have
local boards of health.
Throughout the recent crises,
the CDC's Health Alert Network and Lab Alert Network immediately
notified state and local health departments of the latest
on anthrax and the possibilities of other bioterrorism
attacks. In fact, the Health Alert Network was used September11
to immediately put state health departments on alert for
anything suspicious following the attack on the World
The cases in Florida provided
a good example of how CDC worked with state and local
officials. After the first case there resulted in death,
the CDC moved quickly to confirm the case of the second
victim early on the evening of October 7. The CDC, HHS,
FBI, DOJ, Florida Governor's Office, Florida Public Health
Department and local public health department quickly
formulated a plan that got the word out overnight to AMI
employees that they needed to come to the clinic for medicine
and testing that very next morning. The CDC shipped medicine
to Florida overnight so it was there when people arrived
in the morning. And CDC/Florida officials issued a joint
release at 11 p.m. on October 7 notifying the media and
public of the second case. So it was a good example of
local, state and federal officials working together to
get out a message, send medicine and mobilize people to
come get treatment - literally overnight on a Sunday evening.
In a federalist system,
there are going to be communication challenges between
federal, state and local government. In all of the anthrax
situations, for example, once the CDC receives initial
test results, it promptly begins doing more accurate confirmatory
tests. But a mayor or governor may decide to go out and
talk to the media before the confirmatory tests are concluded.
Those officials make the decision whether to do that based
upon their perception of the needs of the community. We
respect those decisions. At the same time, when you try
to communicate that tests are merely "preliminary," you
hope the public and the media hear that and appreciate
what that means.
Health Care Delivery System
The second level consists
of the health care delivery system, including the private
sector, which, although we refer to it as "private," is
very much a part of the public health infrastructure.
Health care providers have a major role to play in limiting
the prevalence of disease and in reporting unusual occurrences
on a regular basis, not only in times of high alert. They
serve on the front lines and play a valuable role in our
ability to ensure rapid detection of outbreaks through
regularly reporting unusual diseases to the Public Health
Service. Likewise, the Public Health Service must provide
feedback to providers.
HHS and CDC worked extensively
to reach out to various groups within the delivery system
to inform them of what we knew. The Secretary met early
on with the medical associations, the biotech industry,
the pharmaceutical industry, the food industry to address
bioterrorism concerns. He and CDC did a conference call
with the State and Territorial Health Departments Association.
He gave a speech, along with the SG, at the annual meeting
of the American Public Health Association.
We also realized that there
are tremendous opportunities to strengthen our lines of
communication at this level through the use of conference
calls and through satellite and video technologies. CDC
and HHS has done two major conferences with physicians
and hospitals on anthrax, smallpox and bioterrorism. We
must continue to look for new ways to reach out aggressively.
The third level is by no
means any less important than the other two, especially
since they also serve on the front lines: the public.
Bioterrorism attacks will first impact the public, either
individually or in groups. We rely on the public to seek
treatment or advice regarding unusual occurrences and
to assist health care providers in their efforts to detect
diseases early. In order for this to happen, they must
have access to quality health care. Moreover, the public
must cooperate with health care providers by taking prophylactics
as prescribed and avoiding panic.
The public must also be
informed and educated about good public health habits,
such as handwashing, safe handling and washing of foods,
thoroughly cooking meats, and careful handling of suspicious
mail and packages.
After October 4, we immediately
made available to the media an array of medical/scientific
spokespeople in addition to myself and Secretary Thompson,
including CDC Director Jeffrey Koplan, Tony Fauci at NIH,
the Secretary's recently named special advisor D.A. Henderson,
and other officials at CDC, NIH and FDA. The Secretary
remained readily available, and other specialists were
made available when needed. The CDC also made officials
available to the local media during the news conferences
conducted by local officials, whether in Florida, New
York, or Washington.
One challenge we faced in
these situations was the volume of demand. There were
so many news shows and networks who wanted people to interview,
there was no way one person could have met the media demand.
By making several people available, we could more readily
service this demand and at the same time draw upon the
diversity of expertise that we had available.
On the second week in October,
the Secretary and senior members of the HHS team began
doing daily teleconferences with the media. These teleconferences
allowed us to overcome geographic divides and bring in
people from various offices with different areas of expertise.
About a week or so after the Secretary began doing his
conference calls, the CDC began doing daily press calls
In the face of this unprecedented
threat, our communication got stronger as each day passed.
When bumps were hit, they
were quickly addressed.
Criminal Justice System
Let me also add that in
instances of naturally occurring disease outbreaks, those
three levels would be sufficient. But because the disease
outbreak in bioterror is intentionally triggered, public
health emergency response must also include the criminal
justice system as part of its infrastructure, while striving
to maintain appropriate independence.
Let me outline several recommendations
in terms of where we believe we should go from here.
- We must continue to strengthen
the public health infrastructure. We believe that the
best and most successful response to bioterrorism is
to have a well-prepared, well-rehearsed, strong and
flexible public health infrastructure. We must ensure
that all components of that infrastructure are strengthened.
- We must continue to improve
educational opportunities and information sharing between
the Public Health Service and front-line health providers.
Many doctors at the local level still fail to report
disease diagnoses to federal officials, and federal
officials sometimes fail to provide local officials
with a national picture on a timely basis. The mechanisms
must be put in place to ensure that we have an ongoing
dialogue that will make it easier for providers to access
information. One of the ways to do that is through regularly
scheduled satellite broadcasts that they can tune into
in their offices or at a local site within their community.
- The old saying is still
true that all public health is local, so there must
be local efforts as well to educate the community, as
well as health care providers.
- We believe the nation
will benefit from a clear and coordinated communications
strategy for responding to acts of bioterrorism.
Mr. Chairman, the optimal
response to bioterrorism requires a well coordinated
response before, during and after an attack. Communication
is the glue. We realize that there are many opportunities
for us to strengthen our communications role, and we
will continue to strengthen our ability to respond to
such situations in the most timely and accurate manner
possible. The people of this country deserve nothing
This concludes my testimony.
I would be happy to answer questions from you or Members
of the Subcommittee.
HHS Home (www.hhs.gov) |
Topics (www.hhs.gov/SiteMap.html) |
What's New (www.hhs.gov/about/index.html#topiclist) |
For Kids (www.hhs.gov/kids/) |
FAQs (answers.hhs.gov) |
Site Info (www.hhs.gov/SiteMap.html) |
Disclaimers (www.hhs.gov/Disclaimer.html) |
Privacy Notice (www.hhs.gov/Privacy.html) |
FOIA (www.hhs.gov/foia/) |
Accessibility (www.hhs.gov/Accessibility.html) |
Contact Us (www.hhs.gov/ContactUs.html)
revised: November 30, 2001