William F. Raub, Ph.D.

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Testimony
Before the Committee on Government Reform Subcommittee on National Security, Veterans Affairs and International Relations
United States House of Representatives
Combating Terrorism - Protecting The United States: The Role of HHS's Office of Public Health Preparedness
Statement of
William F. Raub, Ph.D.
Deputy Director,
Office of Public Health Preparedness,
HHS
For Release on Delivery
Expected at 1:00 pm
on Thursday, March 21, 2002

Good morning, Mr. Chairman and members of the Subcommittee. I am William F. Raub, Deputy Director of the Office of Public Health Preparedness, Department of Health and Human Services (HHS). I welcome this opportunity to apprise the Subcommittee about HHS activities related to protecting the United States from terrorist attacks.

THE OFFICE OF PUBLIC HEALTH PREPAREDNESS

In the wake of the terrorist attacks in September and October, 2001, Secretary Thompson acted to strengthen HHS anti-terrorism programs by creating the Office of Public Health Preparedness (OPHP) within the Office of the Secretary and recruiting as its first Director Dr. Donald A. Henderson, an internationally acclaimed leader in public health. OPHP directs and coordinates HHS preparedness and response activities related to bioterrorism and other public health emergencies. The HHS program includes enhancement of state and local preparedness; development and maintenance of critical federal government response assets (such as the National Pharmaceutical Stockpile and the National Disaster Medical System); research and development toward new vaccines, diagnostics, and drugs; and liaison with key organizations outside HHS (such as the White House Office of Homeland Security and the academic and industrial communities).

TOPICS FOR WHICH THE SUBCOMMITTEE REQUESTED COMMENTS

The Chairman's letter of February 28 to Secretary Thompson listed six topics to be addressed during this hearing. The remainder of this statement comprises HHS' comments on those topics.

1. "the extent to which the Department of Health and Human Services (HHS) coordinates with, and provides input to the Office of Homeland Defense in their development of a national strategy to counterterrorism."

HHS coordinates its anti-terrorism activities closely with the Office of Homeland Security (OHS). Secretary Thompson and Dr. Henderson are in frequent contact with OHS Director Ridge regarding multi-Department activities as well as specific HHS initiatives. For example, Dr. Henderson recently briefed OHS staff about HHS awards of more than $1 billion via cooperative agreements to all 50 States, 4 selected major municipalities (the District of Columbia, Los Angeles County, Chicago, and New York City), and the 5 U.S. territories to foster state and local preparedness for bioterrorism, other outbreaks of infectious disease, and other public health threats and emergencies. In addition, the Deputy Director of HHS, Claude Allen, participates routinely as a member of the Office of Homeland Security's Deputies Committee, which is the primary senior-level mechanism for inter-Departmental communication and coordination. Also, several other HHS senior staff participate in more specialized inter-Departmental groups, called Policy Coordinating Committees, that support the work of the Deputies Committee.

2. " how your agency establishes priorities for the additional counter terrorism funds received, and measurable achievements"

Priorities for the use of HHS counterterrorism funds are the result of the confluence of the priorities articulated by the President in his budget requests and the priorities specified by the Congress in the regular and supplemental appropriations for fiscal year 2002. In general, HHS is directing its investments toward enhanced preparedness for bioterrorism, other outbreaks of infectious disease, and other public health threats and emergencies, with anti-bioterrorism enhancements at local, state, and national levels as job number one.

Guided by this strategic framework, HHS' primary emphasis areas are as follows: (a) enhancing state and local preparedness; (b) improving HHS response assets to support municipalities and states as needed; (c) developing and procuring safer and more effective vaccines against smallpox and anthrax; (d) developing better diagnostic tests, drugs, and vaccines for the microorganisms most likely to be used by terrorists, and (e) reinforcing and augmenting border coverage of all imported products particularly foods through increased inspectional and laboratory resources and coordination with the U.S. Customs Service. Within the first category, state and local preparedness, the HHS focus is on improving the capabilities of state health departments, local health departments, hospitals, and Metropolitan Medical Response Systems to respond to terrorist-related events, including our ability to communicate at all levels among responders and to the public during a public health emergency. Within the second category, HHS response assets, the HHS focus is on improving the infectious disease surveillance and broader emergency response capabilities of the Centers for Disease Control and Prevention, augmenting the size and scope of materials within the National Pharmaceutical Stockpile and ensuring rapid deployment of these materials as needed; and on further developing the National Disaster Medical System.

HHS is striving for measurable achievements in all these areas. For example, the recently awarded cooperative agreements to enhance the terrorism-related capabilities of health departments and hospitals feature particular "critical benchmarks," "critical capacities," and other specific objectives that the States and other eligible entities are expected to achieve. In a similar vein, HHS has outlined specific objectives for its further investments in the National Pharmaceutical Stockpile, the National Disaster Medical System, and smallpox vaccine development and acquisition. The Department would be pleased to provide additional information on these activities as the Subcommittee may desire.

3. "agency efforts to coordinate the planning, training, and consequence management actions among federal, state, and local agencies"

HHS has had a longstanding role with respect to the Federal Response Plan --working closely with the Federal Emergency Management Agency, the Department of Justice, and other agencies as appropriate. In particular, under the Federal Response Plan, HHS is the lead agency within the federal government for addressing the medical and public health consequences of all manner of mass casualty events whether terrorist-induced, accidental, or naturally occurring. This responsibility is codified as Emergency Support Function #8.

HHS is also working to coordinate planning, training, and consequence management actions at the State and local levels. The recently awarded cooperative agreements to enhance the terrorism-relevant capabilities of health departments and hospitals across the nation emphasize state-wide and regional planning, training of health professionals and other responders, and medical and public health preparedness and response to mass casualty events. As work under the cooperative agreements progresses, HHS will collaborate with its state and municipal partners in identifying exemplary practices in these and other preparedness areas and promoting common approaches wherever appropriate. For example, in striving to help states and municipalities strengthen their information technology capabilities, HHS will place a high priority on achieving interoperability of communications systems and databases.

4. "your feedback from the private sector about the role they will play in addressing the priorities you have identified"

The private sector seems able and eager to help advance the HHS priorities. In the vaccine development area, representatives of the pharmaceutical industry have stressed that, to the extent that the federal government can prescribe its vaccine requirements and assure up front that the requisite funds will be available, the industry will meet the challenge. Thanks to the President's leadership and Congressional appropriations for fiscal year 2002, this currently is the case for the HHS effort to develop and acquire a sufficient quantity of a new smallpox vaccine to protect the entire U.S. population. HHS is hopeful for a similar scenario to be realized for a new anthrax vaccine, if the advanced development work during fiscal year 2002 is successful and if the President's request for $250 million for anthrax vaccine acquisition in fiscal year 2003 is approved by the Congress.

The private sector also is active in other pertinent areas. Development of new or improved multi-spectrum antibiotics is a high priority for the pharmaceutical industry. Many companies, large and small, are attempting to develop rapid diagnostic tests and devices for microbes likely to be used by terrorists. Still other companies, large and small, are pursuing new information technologies and systems that may prove valuable for infectious disease surveillance and hospital response to mass casualty events.

For the purpose of providing the private sector with a single Department of Health and Human Services point of contact and maximizing the opportunities for public private partnerships, Secretary Thompson established the Council on Private Sector Initiatives to Improve the Security, Safety, and Quality of Health Care. The Council is triaging requests from individuals and firms seeking review of their ideas or products and forwarding information to the appropriate agencies and offices. This system ensures that DHHS responds systematically and consistently to private sector requests.

The food industry has actively engaged in strengthening security measures at food processing facilities, restaurants, and retail establishments through establishment of the Alliance for Food Security. In January of this year, the Food and Drug Administration published food security guidance for the domestic and imported food industries. The guidance provides a checklist of potential preventive measures that these firms can take to reduce the risk that food under their control will be subject to tampering, criminal, or terrorist action.

5. "other actions to facilitate the production of new therapeutic medicines and vaccines against the toxins and agents sought by terrorists"

HHS-funded research, primarily through the National Institutes of Health, is attempting to produce new knowledge that will enable the development of new or improved anti-bioterrorism capabilities. Foremost among these efforts is the rapidly expanding array of studies in microbial genomics. By sequencing the genomes of the various species and strains of the microbes most likely to be used by terrorists and by performing comparative analysis of these genomes and their protein products, scientists hope to achieve fresh leads for the development of new or improved diagnostic devices, drugs, and vaccines. Moreover, such research (often referred to as comparative microbial genomics and proteomics) also may yield new insights into the genetic basis for why different species of microbes (or even different strains of the same species) differ from one another, often substantially, in either their virulence or their susceptibility to antibiotics. The results of such research not only could spur advanced development and commercialization of new diagnostic, therapeutic, and prophylactic products but also could enable more informed preventative and therapeutic strategies using existing products.

6. "additional steps which need immediate attention to protect United States citizens from terrorist attacks"

HHS recognizes that much remains to be done to ensure our nation is adequately prepared for bioterrorism, other outbreaks of infectious disease, and other public health threats and emergencies. For example, a robust infrastructure for infectious disease surveillance will require continuous improvement over the next several years. Moreover, the development and commercialization of new diagnostics, drugs, and vaccines almost inevitably are complex scientific and technical endeavors and rarely proceed on a predictable course or time line. Nevertheless, despite these formidable challenges and uncertainties, HHS believes that its fundamental anti-terrorism strategy is sound and notes that it is already yielding solid incremental enhancements in local, state, and national capabilities to ensure homeland security. The major challenge at present is to invest in enhanced local, state, and national capabilities as rapidly yet responsibly as possible. HHS is prepared to stay the course. Our Nation's security demands nothing less.

Last revised: March 22, 2002