Testimony

Statement by
Jerome M. Hauer, M.H.S.
Acting Assistant Secretary for Public Health Emergency Preparedness, U.S. Department of Health and Human Services
on
Combating the SARS Outbreak
before the
House Subcommittee on Oversight and Investigations, Committee on Energy and Commerce

May 7, 2003

Thank you, Mr. Chairman and members of the Committee. I am Jerome M. Hauer, Acting Assistant Secretary for Public Health Emergency Preparedness. I appreciate this opportunity to share our Department's response to the SARS virus within the context of public health emergency preparedness. Dr. Gerberding, Dr. Fauci, and Dr. Lumpkin will speak to the clinical details of the response, so I will keep my comments focused on more global issues and coordination.

The Department of Health and Human Services continues to work vigorously to ensure the Nation's response readiness to terrorism and other public health emergencies. We are doing this by pursuing a multi-pronged approach that consists of enhancing public health and hospital preparedness at state and local levels, and conducting research and development on countermeasures for the biological, radiological, and chemical agents most likely to be used as weapons of mass destruction. As we strengthen our public health infrastructure against bioterrorism, we are simultaneously enhancing our ability to respond to emerging public health threats. There is no question that the work we've done over the past 18 months has prepared us to meet the challenges we are facing in managing the SARS outbreak.

Rarely have the international and national health communities worked so well and so rapidly together in response to an emerging infectious disease. As soon as the international community became aware of the SARS situation in March, the Director General of the World Health Organization was in communication with the experts at HHS headquarters in Washington and the CDC offices in Atlanta. Despite the seriousness of the virus' impact worldwide, we have reason to be encouraged by the response to SARS for several reasons. First, the identification of the agent that causes the disease was completed in record time. CDC identified the coronavirus within a few short weeks of receiving the first specimens from Asia. In contrast, scourges including HIV, legionella, and Lyme Disease took a year or even longer to pinpoint. The unprecedented cooperation between the World Health Organization, HHS headquarters and CDC headquarters in Atlanta resulted in significant progress. We had and continue to have daily video conference calls to share information, map the response, and coordinate our activities. We have deployed teams of experts and support staff to each of the impacted countries, including Canada, mainland China, Hong Kong, Taiwan, the Philippines, Singapore, Thailand and Vietnam to collect first-person data and to assist in conducting surveillance and epidemiologic studies, and the implementation of infection control precautions and other interventions.

We are partnering with industry to organize a full-court press on vaccine development. We are taking maximum advantage of technology to facilitate information sharing; the map of the SARS virus genome was published on the Internet soon after it was successfully sequenced by an international team of laboratories including CDC and Health Canada.

Improvements in laboratory capacity and coordination that we've made recently as part of enhancing our overall public health preparedness has contributed to the speed and accuracy with which we've responded to SARS. The technology built into the Secretary's Command Center has been indispensable - providing a forum for real-time, face-to-face exchange of information with public health officials in Atlanta, Toronto and Geneva. Secretary Thompson has communicated directly with officials in China via telephone conference call. The Command Center maps the distribution of SARS cases across the globe with geographic information system software for use during our planning discussions. The Command Center did not exist a year ago - it became operational last November.

Although the situation in Canada appears to be coming under control, it is critical that we be prepared to confront an outbreak of SARS on U.S. soil. To this end, I recently co-chaired a meeting of the Council of Governments with Mike Byrne of the Department of Homeland Security to bring together health professionals from across the national capital region to aggressively prepare for an outbreak of the SARS virus here. One of the most important elements of an effective response plan is the development of hospital surge capacity. I should note that these preparations are applicable to a broad range of public health emergencies. Our team is unified and ready to deal with a variety of health response issues.

We are taking a variety of steps to ensure that states and other awardee jurisdictions have the resources they may require immediately to strengthen and upgrade their readiness. In FY 2002, we awarded $1.1 billion to 50 states, 3 municipalities, and the American territories to enhance public health preparedness and to upgrade the readiness of hospitals and other healthcare entities to address bioterrorism and other public health emergencies. In FY 2003, CDC and HRSA will award an additional $1.4 billion to further enhance state and local preparedness. In addition, HRSA will provide $28 million to academic health centers and other health professions training entities for a new initiative -- bioterrorism preparedness education and training for clinical providers.

The bioterrorism preparedness funding has made a material difference at the state and local levels. Over 90% of the 50 states and three municipalities (New York City, Chicago and Los Angeles County) that have been awarded funds have developed systems for 24/7 notification or activation of their public health emergency response plans, and 87% of these grantees have developed interim plans to manage and distribute pharmaceuticals, equipment and supplies from the Strategic National Stockpile. In 95% of the jurisdictions, systems are being developed to receive and evaluate urgent disease reports on a 24/7 basis. Ninety-one percent indicated that they could initiate a field investigation within six hours of an urgent disease report.

While our state and local partners work to improve their preparedness and response capabilities, the Department is implementing an aggressive research and development program to develop and acquire biological, chemical, nuclear and radiological countermeasures. These initiatives have involved close coordination among NIH, CDC, FDA, DoD, and the Office of the Assistant Secretary for Public Health Emergency Preparedness. Research programs at NIH, involving a broad array of scientific initiatives, provide new approaches for developing countermeasures to threat agents most likely to be used as terrorist weapons. NIH is conducting and supporting basic research in immunology, microbiology, disease pathogenesis, genome sequencing and proteomics related to the organisms/toxins that could be used as bioterrorist agents. Both NIH and CDC support not only early product development efforts but also advanced development that is carried out in collaboration with industry partners. The FDA works very closely with these partners to provide advice and guidance during the development process with a view towards facilitating their subsequent submissions for regulatory review.

The research and development efforts are on a very compressed timetable and reviews of their progress are discussed on a regular basis by an interagency team consisting of NIH, CDC and FDA.

The most exciting news in the R&D arena is, of course, Project BioShield, announced by the President on February 3, 2003. BioShield is a comprehensive and ambitious effort to develop and make available modern, effective drugs and vaccines to protect against attacks by biological and chemical weapons. BioShield seeks to: encourage industry participation in the effort develop and procure next-generation medical countermeasures by establishing a stable source of funding; ensure that NIH has the authority to expedite the research and development of promising countermeasures; and to give the FDA authorization that would permit and facilitate the emergency use of preventive and therapeutic countermeasures that have not yet completed the formal process for full FDA licensure.

These are truly challenging times for our Department. I believe that we are up to the task and we look forward to working closely with Congress to ensure that the Nation is prepared to respond to public health emergencies in general and terrorism in particular.

Mr. Chairman, thank you for the opportunity to appear before the committee. My colleagues and I will be glad to take any questions that you and other members of the Committee may have.

Last Revised: May 7, 2003