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Testimony on Bioterrorism by William Clark
Deputy Director, Office of Emergency Preparedness
U.S. Department of Health and Human Services

Before the Senate Health, Education, Labor & Pensions Committee, Subcommittee on Public Health and Safety
March 25, 1999

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 Nation’s readiness to medically respond to acts of biological terrorism against civilian populations within the United States .

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 Clinton’s 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 and Science.

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 local systems.

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 areas.

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 Service’s Commissioned Corps Readiness Force.

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 following.

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 President’s 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 Department’s 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 Executive 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 Executive 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 Bioterrorism initiative.

Mr. Chairman, that concludes my prepared remarks. I would be pleased to answer any questions that you may have.

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