Mr. Chairman and Members of the Committee,
My name is Bill Clark, and I am the deputy Director of the Office of Emergency
Preparedness (OEP) within the Department of Health and Human Services (HHS). I have over
40 years of experience at the city, county, state and federal level in emergency services.
I am pleased to appear before you today to discuss the Nations readiness to
medically respond to acts of biological terrorism against civilian populations within the
As a Nation we are becoming more fully prepared to rapidly detect and effectively
respond to the human health effects of a major incident involving the release of
biological agents by terrorists. However, we still have to do more. Our initial seminal
efforts began in 1995, following the nerve gas attack against the Tokyo subways, when our
office sponsored a unique conference bringing together international, federal, state, and
local health and medical professionals to discuss responding to the consequences of
chemical and biological terrorism.
We recognize the challenges of what needs to be accomplished, and we are now
implementing the first year of President Clintons Bioterrorism initiative that was
supported by the Congress in the fiscal year 1999 budget. In the HHS Bioterrorism program,
the Centers for Disease Control and Prevention is addressing the public health
infrastructure needs, the National Institutes of Health is expanding its research into
vaccines and therapies, the Food and Drug Administration is focusing additional resources
on rapidly reviewing candidate therapies and vaccines against various biological agents,
and OEP is addressing the medical response needs.
Presidential Decision Directive 62, "Protection Against Unconventional Threats to
the Homeland and Americans Overseas," recognizes the Federal Emergency Management
Agency as the lead for coordinating consequence management and designates HHS as the lead
federal agency to plan and prepare for a national response to medical emergencies arising
from the use of weapons of mass destruction by terrorists. Within HHS, this responsibility
is coordinated by the Office of Emergency Preparedness within the Office of Public Health
Our strategy is to develop complimentary medical response systems capabilities at local
and national levels. We are taking a "bottom up" approach and have been working
in partnership with local governments in 27 geographic areas to enhance their existing
Although our previous emphasis has been primarily focused on the initial medical
management of a chemical incident, we are now giving equal priority to Bioterrorism
medical response planning and preparedness. This year we plan to expand our Metropolitan
Medical Response System (MMRS) program to work with a total of 47 major metropolitan
At the national level, we have been working with our federal partners to enhance the
National Disaster Medical System (NDMS) to be prepared to respond to WMD incidents to
assist the affected local jurisdictions as might be necessary. NDMS is a partnership
between HHS, the Department of Defense (DOD), the Department of Veterans Affairs (VA), the
Federal Emergency Management Agency (FEMA), and the private sector. Additionally, OEP has
the responsibility for managing the Public Health Services Commissioned Corps
It is our view that the initial burden resulting from a major biological attack would
primary be the responsibility of local government, with support from state and federal
agencies. In such a scenario, key public health and medical response actions that would be
taking place once people were aware that such an attack had occurred would include the
The Centers for Disease Control and Prevention would assist local and state government
with making the determination of what has occurred, identifying what agent has been
utilized, and identifying the population at risk
OEP would assist the local government with providing mass patient care including the
establishment of auxiliary, temporary treatment facilities; providing mass immunization or
prophylactic drug treatment for those known to have been exposed, those who may have been
exposed, and those not already exposed but at risk of exposure from secondary transmission
and/or the environment; and providing respectful and safe disposition of the deceased.
Probably one of the more daunting challenges of such a scenario is the possibility that
we would have to vaccinate or prophylax hundreds of thousands of persons within a 24 to 48
hour time frame.
Both CDC and OEP would be coordinating with local government, state environmental and
health officials, and the Environmental Protection Agency in assessing the extent of
contamination of the environment and identifying risk management steps to assure safe
re-entry of the potentially contaminated areas.
Are we prepared for such a scenario? Today, I must say that our medical bioresponse
capabilities are limited, but we are using the $160 million appropriated for Bioterrorism
in FY 99 to change that, and the Presidents FY 2000 budget seeks a 44 percent
increase in funding to further improve our capacity to protect our citizens. Most cities
do not have biological medical response plans in place yet. The public health
infrastructure is beginning to be enhanced under the lead of CDC. Funding for the first
national pharmaceutical stockpile has been appropriated, and CDC is working to make the
stockpile. Local Metropolitan Medical Response System biological preparedness development
has been underway for three (3) years, and is making good progress under the lead of OEP.
Our efforts to bolster state and local capabilities to respond to chemical or
biological attack are being coordinated with other federal assistance programs, such as
those established under the Defense Departments Nunn-Lugar-Domenici program, through
the Office of the National Coordinator for Security, Infrastructure Protection and
Counter-Terrorism within the National Security Council. We are also working with the
National Domestic Preparedness Office, which has recently been established within the FBI.
OEP is working with the physician, nursing and hospital community to assure that
appropriate professional education and standards of care are developed for the treatment
of those who might be exposed to chemical or biological agents.
Research and development needed to improve civilian medical response to chemical and
biological terrorism incidents has been expanded in FY 99, and the FY 2000 budget contains
additional resources for development of vaccines for smallpox and anthrax and for the
review of candidate drugs and vaccines by the FDA. An R&D workplan has just been
identified by the Institute of Medicine under a contract with OEP. We have shared this
report with our colleagues in the Office of Science and Technology Policy within the
Office of the President and we understand that they are using this report as its
framework for assessing and coordinating counterterrorism related R&D throughout the
branch to mitigate, counter, or respond to chemical or biological terrorism.
In closing, OEP has and will continue to involve our partners, both within the
department and externally with our interagency colleagues, as we implement our
Mr. Chairman, that concludes my prepared remarks. I would be pleased to answer any
questions that you may have.