[House Hearing, 111 Congress]
[From the U.S. Government Printing Office]
BEYOND READINESS: AN EXAMINATION OF THE CURRENT STATUS AND FUTURE
OUTLOOK OF THE NATIONAL RESPONSE TO PANDEMIC
INFLUENZA
=======================================================================
HEARING
COMMITTEE ON HOMELAND SECURITY
HOUSE OF REPRESENTATIVES
ONE HUNDRED ELEVENTH CONGRESS
FIRST SESSION
__________
JULY 29, 2009
__________
Serial No. 111-32
__________
Printed for the use of the Committee on Homeland Security
[GRAPHIC NOT AVAILABLE IN TIFF FORMAT]
Available via the World Wide Web: http://www.gpoaccess.gov/congress/
index.html
__________
U.S. GOVERNMENT PRINTING OFFICE
53-650 PDF WASHINGTON : 2009
-----------------------------------------------------------------------
For sale by the Superintendent of Documents, U.S. Government Printing
Office Internet: bookstore.gpo.gov Phone: toll free (866) 512-1800; DC
area (202) 512-1800 Fax: (202) 512-2250 Mail: Stop SSOP, Washington, DC
20402-0001
COMMITTEE ON HOMELAND SECURITY
Bennie G. Thompson, Mississippi, Chairman
Loretta Sanchez, California Peter T. King, New York
Jane Harman, California Lamar Smith, Texas
Peter A. DeFazio, Oregon Mark E. Souder, Indiana
Eleanor Holmes Norton, District of Daniel E. Lungren, California
Columbia Mike Rogers, Alabama
Zoe Lofgren, California Michael T. McCaul, Texas
Sheila Jackson Lee, Texas Charles W. Dent, Pennsylvania
Henry Cuellar, Texas Gus M. Bilirakis, Florida
Christopher P. Carney, Pennsylvania Paul C. Broun, Georgia
Yvette D. Clarke, New York Candice S. Miller, Michigan
Laura Richardson, California Pete Olson, Texas
Ann Kirkpatrick, Arizona Anh ``Joseph'' Cao, Louisiana
Ben Ray Lujan, New Mexico Steve Austria, Ohio
Bill Pascrell, Jr., New Jersey
Emanuel Cleaver, Missouri
Al Green, Texas
James A. Himes, Connecticut
Mary Jo Kilroy, Ohio
Eric J.J. Massa, New York
Dina Titus, Nevada
Vacancy
I. Lanier Avant, Staff Director
Rosaline Cohen, Chief Counsel
Michael Twinchek, Chief Clerk
Robert O'Connor, Minority Staff Director
C O N T E N T S
----------
Page
STATEMENTS
The Honorable Bennie G. Thompson, a Representative in Congress
From the State of Mississippi, and Chairman, Committee on
Homeland Security:
Oral Statement................................................. 1
Prepared Statement............................................. 2
The Honorable Peter T. King, a Representative in Congress From
the State of New York, and Ranking Member, Committee on
Homeland Security:
Oral Statement................................................. 3
The Honorable Paul C. Broun, a Representative in Congress From
the State of Georgia:
Prepared Statement............................................. 3
The Honorable Stephen F. Lynch, a Representative in Congress From
the State of Massachusetts:
Prepared Statement............................................. 4
WITNESSES
Panel I
Ms. Jane Holl Lute, Deputy Secretary, Department of Homeland
Security:
Oral Statement................................................. 5
Prepared Statement............................................. 7
Mr. William Corr, Deputy Secretary, Department of Health and
Human Services:
Oral Statement................................................. 10
Prepared Statement............................................. 12
Ms. Bernice Steinhardt, Director, Strategic Issues, Government
Accountability Office:
Oral Statement................................................. 16
Prepared Statement............................................. 17
Panel II
Ms. Colleen M. Kelley, President, National Treasury Employees
Union:
Oral Statement................................................. 46
Prepared Statement............................................. 48
Mr. Richard G. Muth, Executive Director, Maryland Emergency
Management Agency:
Oral Statement................................................. 51
Prepared Statement............................................. 54
Dr. Mark B. Horton, M.D., M.S.P.H., Director, California
Department of Public Health, and State Health Officer:
Oral Statement................................................. 60
Prepared Statement............................................. 62
Dr. Thomas A. Farley, M.D., New York City Department of Health
and Mental Hygiene:
Oral Statement................................................. 68
Prepared Statement............................................. 70
APPENDIX
Questions From Chairman Bennie G. Thompson of Mississippi for Ms.
Jane Holl Lute, Deputy Secretary, Department of Homeland
Security....................................................... 85
Questions From Chairman Bennie G. Thompson of Mississippi for
William Corr, Deputy Secretary, Department of Health and Human
Services....................................................... 98
Questions From Ranking Member Peter T. King of New York for
William Corr, Deputy Secretary, Department of Health and Human
Services....................................................... 101
Questions From the Honorable Michael T. McCaul of Texas for
William Corr, Deputy Secretary, Department of Health and Human
Services....................................................... 101
Questions From Chairman Bennie G. Thompson of Mississippi for Ms.
Bernice Steinhardt, Director, Strategic Issues, Government
Accountability Office.......................................... 102
Questions From Ranking Member Peter T. King of New York for Ms.
Bernice Steinhardt, Director, Strategic Issues, Government
Accountability Office.......................................... 102
Question From Chairman Bennie G. Thompson of Mississippi for Ms.
Colleen M. Kelley, National President, National Treasury
Employees Union................................................ 103
Questions From Chairman Bennie G. Thompson of Mississippi for Mr.
Richard G. Muth, Executive Director, Maryland Emergency
Management Agency.............................................. 103
Questions From Chairman Bennie G. Thompson of Mississippi for Dr.
Mark B. Horton, Director, California Department of Public
Health......................................................... 103
Questions From Chairman Bennie G. Thompson of Mississippi for Dr.
Thomas A. Farley, New York City Department of Health and Mental
Hygiene........................................................ 104
BEYOND READINESS: AN EXAMINATION OF THE CURRENT STATUS AND FUTURE
OUTLOOK OF THE NATIONAL RESPONSE TO PANDEMIC INFLUENZA
----------
Wednesday, July 29, 2009
U.S. House of Representatives,
Committee on Homeland Security,
Washington, DC.
The committee met, pursuant to call, at 2:00 p.m., in Room
311, Cannon House Office Building, Hon. Bennie G. Thompson
[Chairman of the committee] presiding.
Present: Representatives Thompson, Harman, Jackson Lee,
Cuellar, Carney, Richardson, Kirkpatrick, Lujan, Pascrell,
Cleaver, Green, Himes, King, Rogers, McCaul, Dent, Bilirakis,
Olson, and Cao.
Chairman Thompson. The committee on Homeland Security will
come to order.
As a matter of housekeeping, our reporter is in a building
where a suspicious package has been identified and security
will not let anyone out of the building. But they are watching
us on an in-house station doing the reporting and unless they
have to evacuate the building, rest assured, a transcript of
this hearing will take place. But you can understand the
sensitivity of the security, and that is why our recorder is
not present at this point. However, as indicated, we will
continue with the hearing.
The committee is meeting today to receive testimony on
``Beyond Readiness: An Examination of the Current Status and
Future Outlook of the National Response to Pandemic
Influenza.''
I would like to thank our witnesses for appearing before us
today. Today's hearing will review this Nation's state of
preparedness for an influenza pandemic.
In April 2009, the Centers for Disease Control and
Prevention reported two cases of respiratory illness in
children caused by a virus. Those two cases, which occurred
less that 4 months ago, were the first confirmed instances of
H1N1 flu within the United States.
By late June, U.S. health officials estimated that there
had been more than 1 million infections in the United States.
According to the World Health Organization, this virus is
travelling the world with unprecedented speed. There have been
confirmed cases on every continent except Antarctica. While
this may be troubling, there is no need to panic in the face of
this pandemic.
So far, the disease has been mild in most people and
treatments are available. But many scientists and public health
officials are predicting that the virus will surge in the fall.
It is that resurgence which we must be ready to meet. The
Centers for Disease Control and Prevention estimates that as
many as 40 percent of the U.S. population could become infected
with H1N1 over the next 2 years.
The good news is that a vaccine is currently under
development, and over the last 4 years, Congress has provided
approximately $8.6 billion for pandemic planning efforts. But
unfortunately, despite this amount of funding, according to GAO
there are still major gaps in pandemic planning and
preparedness efforts. Among the major gaps is the failure to
plan for additional bed space and medical supplies.
Additionally, GAO determined that leadership roles and
responsibilities for an influenza pandemic need to be further
clarified, tested, and exercised. Given this country's recent
experience with disasters, it is hard to believe that there are
those who underestimate the importance of plans and drills. Our
children are taught in school what to do in a fire drill. They
are not taught to wait until a fire starts, yell instructions,
and hope everybody makes it to the exit. We teach them that
planning and practice increases their chance of survival. That
elementary school lesson still applies.
Finally, we need to understand that the emergency
preparedness and response community and the health care
community have always shared resources during crises and
disasters. These formal and informal partnerships may be
strained during a pandemic. Increased drills and exercises will
strengthen these relationships, decrease uncertainty, and
improve response and recovery.
I want to thank our witnesses and look forward to their
testimony today. The Chair now recognizes the Ranking Member of
the full committee, the gentleman from New York, Mr. King, for
an opening statement.
[The statement of Chairman Thompson follows:]
Prepared Statement of Chairman Bennie G. Thompson
July 29, 2009
In April 2009, the Centers for Disease Control and Prevention (CDC)
reported two cases of respiratory illness in children caused by a
virus. Those two cases, which occurred less than 4 months ago, were the
first confirmed instances of H1N1 flu within the United States. By late
June, U.S. health officials estimated that there had been more than 1
million infections in the United States.
According to the World Health Organization, this virus is
travelling the world with ``unprecedented speed''. There have been
confirmed cases on every continent except Antarctica.
And while this may be troubling, there is no need to panic in the
face of this pandemic. So far, the disease has been mild in most people
and treatments are available. But many scientists and public health
officials are predicting that the virus will resurge in the fall. And
it is that resurgence which we must be ready to meet.
The Centers for Disease Control and Prevention estimates that as
many as 40 percent of the U.S. population could become infected with
H1N1 over the next 2 years. The good news is that a vaccine is
currently under development and over the last 4 years Congress has
provided approximately $8.6 billion for pandemic planning efforts. But
unfortunately, despite this amount of funding, according to GAO there
are still major gaps in pandemic planning and preparedness efforts.
Among the major gaps, is the failure to plan for additional bed
space and medical supplies. Additionally, GAO determined that
leadership roles and responsibilities for an influenza pandemic need to
be further clarified, tested, and exercised. Given this country`s
recent experience with disasters, it is hard to believe that there are
those who underestimate the importance of plans and drills.
Our children are taught in school what to do in a fire drill. They
are not taught to wait until a fire starts, yell instructions, and hope
everybody makes it to the exit. We teach them that planning and
practice increases their chance of survival. That elementary school
lesson still applies. Finally, we need to understand that the emergency
preparedness and response community and the health care community have
always shared resources during crises and disasters. These formal and
informal partnerships may be strained during a pandemic.
Increased drills and exercises will strengthen these relationships,
decrease uncertainty, and improve response and recovery.
Mr. King. Thank you, Mr. Chairman. Thank you for holding
this hearing. As you indicated, this is a very serious issue.
Apparently, the consensus is that the H1N1 flu is going to
return, and possibly it could be more severe than the first go-
around. I don't have a very long opening statement, but one, I
would like to acknowledge the presence of Dr. Tom Farley, who
is the newly-appointed commissioner of the New York City Health
Department and congratulate him for the job he has done in less
than 2 months, coming in right at the peak of the flu season in
New York.
I also would like to stress some questions I will be asking
during the question-and-answer session.
One is on the issue of the vaccine. I met with Secretary
Lute the other day on this as to what the prospects are for
having a vaccine. Almost as importantly is the educational
process that will go to the public. Already there are rumors
going around that the vaccine could be more harmful and that it
is dangerous to kids, and what is going to be done to stop
those rumors when they start and what can be done to convince
the public that, in fact, this vaccine is expected to work and
certainly will not be dangerous, especially to young children.
Also, the issue, since DHS is obviously a new Department,
and as far as I know, this is the first health crisis that has
affected the country since DHS was started. Secretary Lute,
have you looked back to see lessons learned, how effective the
Department was, how close the coordination was with HHS,
whether or not it was synchronized, and what, if any,
improvements are necessary for the future. Also on the issue
for our employees, TSA, CBP in particular, and what will be
done to protect them as they are doing their job. What are the
appropriate procedures for them?
With that, I look forward to the testimony, Mr. Chairman.
Thank you for the hearing.
Chairman Thompson. Thank you.
Other Members of the committee are reminded that under
committee rules, opening statements may be submitted for the
record.
[The statement of Hon. Broun follows:]
Prepared Statement of the Honorable Paul C. Broun
July 29, 2009
Thank you, Mr. Chairman.
I'd like to welcome our witnesses here today. I'm pleased the
committee is meeting to review and assess the status of H1N1 readiness
efforts to prepare for and respond to pandemic influenza.
As a doctor, I am particularly troubled with the Federal
Government's lack of concern for the protection of Federal employees'
health. I'm sure that you know that I offered amendment earlier this
year that would have allowed any TSA employee to wear a protective
facemask in the event of a pandemic or public health emergency. I was
disappointed that this important amendment was defeated on a party line
vote.
I am particularly concerned by what seems to be a lack of progress
in this area, due in part because of the defeat of my amendment. I
believe that it is absolutely essential that the employees on the front
lines be able to protect themselves by taking extra precautions if they
feel it is in the best interest of their personal health. The
Department needs to adopt a policy immediately to permit its employees
to take precautionary measures to protect their own health.
I am specifically interested in hearing our witnesses' thoughts on
protective equipment measures such as face masks, and what the strategy
is to protect screeners and other personnel at the border and around
the country. I'd like to quote my colleague Congressman Stephen Lynch
who said, ``In my opinion it is unconscionable that our workers have
been denied the use of certain PPE [personal protective equipment]
items--such as N-95 and surgical masks, gloves, and hand sanitizer--and
even threatened for attempting to protect themselves from a
communicable disease.''
I hope our witnesses can convince my colleagues of the importance
and seriousness of this issue and that we can work together in a
bipartisan manner to fix it soon.
Thank you, Mr. Chairman. I yield back the balance of my time.
Chairman Thompson. Without objection, a statement provided
to the committee by Representative Lynch of Massachusetts
addressing the subject matter covered by today's hearing will
be inserted into the record at the appropriate point.
[The statement of Hon. Lynch follows:]
Prepared Statement of the Honorable Stephen F. Lynch
July 30, 2009
I'd like to thank Chairman Thompson for allowing me to submit a
statement for the record for today's hearing.
As Chair of the House's Federal Workforce Subcommittee, I have
monitored closely the Department of Homeland Security's (DHS) response
to the outbreak of the H1N1 virus. DHS employs approximately 225,000
Federal workers who are charged with the tremendous job of keeping the
American public safe, including 52,000 Customs and Border Patrol (CBP)
employees, 50,000 Transportation Security Administration (TSA)
employees, and 17,200 Immigration and Customs Enforcement (ICE)
employees. I feel it is my responsibility to ensure the health and
safety of these Federal employees--especially those on the front-line.
In addition to the on-going emergency preparedness efforts to
secure the public's safety, it is essential that Federal agencies
implement adequate and uniform worker policies that protect the very
employees who will be called upon to respond in the event of an
emergency. Without such policies, not only is the health of front-line
employees being put at risk, but the health of their families and the
general welfare of the public are also placed at risk. In short, the
Federal Government cannot ably respond to emergencies if the very
personnel needed as part of that response are themselves compromised.
I have been troubled by the apparent reluctance on the part of DHS
to address the voluntary use of personal protective equipment (PPE)
amidst the H1N1 flu outbreak. In my opinion it is unconscionable that
our workers have been denied the use of certain PPE items--such as N-95
and surgical masks, gloves, and hand sanitizer--and even threatened for
attempting to protect themselves from a communicable disease. Further,
it is alarming that DHS has not yet distributed written guidance on the
voluntary usage of protective gear to its own employees during a public
health emergency.
These front-line Federal workers--many of whom work well within 6
feet of individuals who could be known or suspected to have the H1N1
virus--deserve to be reassured that their employer--which in this case
is the Federal Government--has done everything possible to guarantee
their health while on the job.
Mr. Chairman, I thank you for holding this timely hearing, and look
forward to working with you to ensure that our Federal workforce's
needs are addressed as our Government prepares for the possibility of a
larger influenza outbreak this fall and winter.
Chairman Thompson. I welcome our first panel of witnesses.
Our first witness is Dr. Jane Holl Lute, Deputy Secretary of
the Department of Homeland Security. As Deputy Secretary, she
is responsible for the operation of our newest Federal
department and the operational coordination of Federal, non-
Federal, and private sector agencies when the Nation is
confronted with events that threaten our homeland. She was
confirmed by the Senate in January 2009 and brings to the
Department over 30 years of military and senior executive
experience in the U.S. Government.
Welcome, Dr. Lute.
Our second witness is Mr. William Corr, the Deputy
Secretary of the Department of Health and Human Services. As
Deputy Secretary, he is responsible for the operations of the
largest civilian department in the Federal Government. Mr. Corr
has extensive management and health care policy experience,
including work for Congress. I welcome him back to the Hill
today.
Our third witness is Ms. Bernice Steinhardt, Director of
Strategic Issues at the Government Accountability Office. She
has studied a number of different health policies and strategic
issues, and has been responsible for producing many of the
reports about pandemic influenza and related issues for our
committee.
We thank all of you for being our witnesses and for your
service to the Nation and for being here today.
Without objection, the witness' full statements will be
inserted in the record. I now ask each witness to summarize
their statement for 5 minutes beginning with Secretary Lute.
STATEMENT OF JANE HOLL LUTE, DEPUTY SECRETARY, DEPARTMENT OF
HOMELAND SECURITY
Ms. Lute. Mr. Chairman, Ranking Member King, distinguished
Members of the committee, it is an honor to appear before you
this afternoon with my colleagues to discuss the Department of
Homeland Security's preparation for a possible resurgence of
H1N1 this fall.
I have to say it is nice to appear before Congress to
discuss something other than myself. As fun as that
confirmation process was, I am happier to be on these sides of
the issue.
In the months since I have been in office, it has been
readily apparent how important the relationship between this
committee and the Department of Homeland Security is. Like all
important relationships, we won't always get it quite right.
But, Mr. Chairman and Ranking Member King, Members of the
committee, I hope you all know that Secretary Napolitano and I
are committed to collaborating with you as we work to make the
United States of America a safer place. We want and need your
support, your ideas, your direction, and the American people
deserve your oversight.
While I recognize that this proceeding is focused on H1N1,
I think it is important to contextualize H1N1 within the
spectrum of threats that Department of Homeland Security
negotiates and navigates every day.
Secretary Napolitano and I often think about our jobs in
the context of managing the supply chain of trouble. Now, I am
sure there is a more sophisticated way to express it, but I am
from New York, so it seems to be a vivid representation of the
challenges we face. Trouble, it will come as no surprise to
this committee, comes in many forms; whether it is a time bomb,
or tornado, a computer virus created by man, or a pandemic
virus created by Mother Nature. Trouble has suppliers,
facilitators, purchasers, producers, distributors, and
customers. These perilous products move through multiple
channels before they reach our shore, and it is the job of the
Department of Homeland Security to understand the supply chain
of trouble and identify opportunities along the way to gather
information, intelligence, interdict, redirect, and stop
trouble before it reaches our shores and our communities, and
to do this in a way that is not only consistent with but that
honors our cherished principles of civil rights, executive
authority, and the important laws that guide our privacy and
liberty.
Just as threats have multiplied and evolved, the Department
of Homeland Security's mission to lead the American effort to
protect itself must adapt to the new supply chains of trouble
that deliver, not just bombs and bullets, but botnets, and now
we know, pandemics.
Nontraditional threats like H1N1 cannot be stopped by
magnetometers or guns or fences. Indeed, H1N1, as the Chairman
has noted, is already here. In fact, it is ever present around
the world.
While we lack a complete understanding of what this fall
will look like, we are planning for the worst. The outbreak of
H1N1 this spring offered an unparalleled window into the state
of our critical pandemic response capabilities and readiness.
In some areas we excel. In other areas, frankly, as this
committee has noted, we still have work to do.
As with all aspects of the Department's work, Secretary
Napolitano has asked me to supervise the staff members
responsible for coordinating lessons learned and ensure that
the Department is ready for whatever the fall may bring. While
the Secretary may be the principal Federal official for
domestic incident management, she is not the sole Federal
official.
The Department of Health and Human Services, I am deeply
honored to be testifying with my HHS colleague, Deputy
Secretary Corr this afternoon, who has a leading role to play
in mounting a response to H1N1, as does the Department of
Education and others, as does Congress.
Indeed, congressional leadership on this issue has been of
particular importance. The $47 million Congress provided to DHS
for pandemic influenza preparedness in fiscal year 2006 has
already proven its worth. With that funding, we have been able
to build the foundation of our pandemic preparedness, including
stockpiling of personal protective equipment and antiviral
drugs for DHS employees and supporting pandemic influenza
workshops.
Our role is to coordinate and assist the larger Federal
response. We are working with the White House, National
security staff and our Federal interagency partners to finalize
the Federal strategic implementation plan for the 2009 H1N1
flu. This plan is being revised to reflect the lessons that we
learned this spring.
Internally, we are finalizing our own operational plans to
provide direction to DHS components to ensure that our mission-
essential functions are maintained while protecting our
workforce in the face of a sustained or worsening outbreak.
While final touches to formal plans are being made, the
overall coordination for this incident began months ago. At the
start of the current outbreak of H1N1, the National Operations
Center was fully activated to fulfill its role on interagency
coordination, and they were assisted in this by the Office of
Health Affairs which coordinated with HHS to help manage
requests for information from a variety of stakeholders.
We have been actively engaged with our Federal, State, and
local and Tribal partners throughout the H1N1 outbreak, and we
are working with others under the direction of President Obama
who hosted a H1N1 summit 3 weeks ago for State and local
leaders and stakeholders. This summit focused on lessons
learned from the response so far. We are helping the private
sector to plan for a pandemic. DHS began providing extensive
guidance to private sector partners several years ago.
Challenges have arisen and we are adapting in view of the
experience gained.
The health and safety of our workforce is one of our
highest priorities, and we will continue to ensure that our
front-line employees receive guidance on personal protection
that is based on the best science available. We learned from
the H1N1 flu that we have to have more guidance in place, and
we have worked in that direction.
There are a number of other efforts throughout the
Department that I detailed in my statement for the record.
Every day, Secretary Napolitano and I wake up thinking
about how we can find new points on the supply chain of trouble
and to interdict that trouble before it makes its way to the
United States. H1N1 is no different. We will be prepared and we
will be ready.
Thank you again for this opportunity to testify. I will be
happy to answer your questions.
[The statement of Ms. Lute follows:]
Prepared Statement of Jane Holl Lute
July 29, 2009
Chairman Thompson, Ranking Member King, and Members of the
committee: Thank you for this opportunity to discuss National efforts
to respond to the H1N1 flu outbreak, and what the Department of
Homeland Security (DHS) is doing to prepare Americans for the effects
of pandemic influenza in the future.
The outbreak of H1N1 this past spring presented us with an early
opportunity to evaluate our capacity to respond to a potential pandemic
influenza. As we ready for the possibility that the H1N1 influenza may
worsen, we must take advantage of what we learned from our earlier
experience with this flu.
Secretary Napolitano has asked me to lead internal coordination of
the Department's response to H1N1. Our efforts within DHS are many, but
we work in close coordination with the Department of Health and Human
Services, the Department of Education, and the many other agencies that
are contributing to the preparedness of our Nation. I am pleased to
testify alongside my colleague, Deputy Secretary Corr, from HHS. We
must, and are, acting in unison to ensure the entire Nation has the
highest level of preparedness possible.
overview of pandemic preparedness and planning within dhs
Before speaking about current and future activities of DHS, I would
like to touch briefly on the past leadership that has allowed us to
reach our current readiness state.
Specifically, I would like to acknowledge the $47.3 million that
Congress allocated to DHS for pandemic influenza preparedness in fiscal
year 2006. The recent outbreak of H1N1 made the importance of this
funding even more evident. With that funding, the Department was able
to build the basis of our pandemic preparedness foundation. For
example, DHS conducted exercises (including intradepartmental pandemic
influenza tabletops and workshops), purchased personal protective
equipment (PPE) for DHS employees, and stockpiled antiviral medications
for employees.
DHS is currently working with White House National Security Staff
and our Federal interagency partners to finalize the Federal Strategic
Implementation Plan for the 2009 H1N1 flu. The draft H1N1
Implementation Plan is being revised to reflect the many policy and
strategic decisions that have been made, lessons learned from the
initial response, and an overarching goal to mitigate the impact of
H1N1 on society and the economy.
At the same time, the Department is finalizing the DHS 2009 H1N1
Operational Plan, which will be completed within the coming weeks. This
plan will provide the necessary direction to DHS components to ensure
that the Department's mission-essential functions are maintained while
protecting our workforce in the face of a sustained or worsening
outbreak.
The Secretary and I are committed to the timely finalization of
both the inter- and intra-agency pandemic flu plans.
incident coordination
While final touches to formal plans are being made, overall
coordination for this incident began immediately as Secretary
Napolitano carried out her responsibilities as the Principal Federal
Official.
At the start of the current outbreak of H1N1, the Department's
National Operations Center (NOC) was fully activated in order to
provide direct support to the Secretary as well as to fulfill its role
of interagency coordination. The NOC was ably assisted by the Office of
Health Affairs (OHA), which coordinated with HHS and helped to manage
requests for information from a variety of stakeholders, including our
own DHS components, Federal interagency partners, State and local
officials, the private sector, and Congress.
To further facilitate incident coordination, DHS recently
established Regional Coordination Teams to serve as an additional
resource for the Federal Government, States, and local communities. The
teams are designed to provide a regional link to our Federal partners;
identify and respond to critical needs; identify and help reconcile
regional issues; and coordinate with safety and health officials to
protect Federal workers. The teams are charged with facilitating
Federal interaction with our State and local partners in a pandemic
where, unlike in many site-specific natural disasters, the affected
population is spread across the entire Nation.
state, local, tribal, and territorial outreach
The Department of Homeland Security has been actively engaged with
our Federal, State, local, territorial, and Tribal partners to prepare
for our national response to an influenza pandemic. DHS offices and
components have worked closely with partners to share information that
is most critical to preparedness plans. During the initial H1N1
outbreak in the spring, DHS' Office of Intergovernmental Programs held
daily information calls and posted daily status updates to fusion
centers through the Homeland Security State and Local Intelligence
Community (HS-SLIC) network. Given the overwhelmingly positive response
that this outreach and engagement received, DHS will continue to use
all mechanisms at hand come this fall, including, but not limited to,
the Homeland Security Information Network, and the Homeland Security
State and local intelligence community, in order to distribute critical
information.
Three weeks ago, following President Obama's direction and
leadership, DHS, HHS, and the Department of Education hosted a summit
for State and local leaders and stakeholders. The summit discussions
focused on lessons learned from the initial wave, including DHS areas
of focus such as continuity of operations planning, front-line employee
protection, and public and private sector roles in the national
response. The summit's multiagency approach was very well-received. It
allowed the Federal Government to convene key leaders and underscore
how critical it is for local communities to coordinate activities among
and between officials from the public health, emergency management,
education, and public and private sectors.
critical infrastructure and private sector preparedness
This history of past efforts and coordination proved beneficial
during the H1N1 outbreak. Prior to the outbreak, DHS had published the
``Pandemic Influenza Preparedness, Response and Recovery, Guide for
Critical Infrastructures and Key Resources'' to provide guidance to our
Critical Infrastructure and Key Resource (CIKR) partners. In addition,
with the help of our interagency partners, DHS completed specific
pandemic influenza plans for all 18 of the CIKR sectors. Important
components of the final plans and overall pandemic preparedness issues
were highlighted, and will continue to be highlighted, in a series of
web seminars led by DHS representatives. DHS is also coordinating with
CIKR partners through the Government Coordinating Councils (GCC) and
Sector Coordinating Councils (SCC).
Across DHS, we are engaged with various private sector
organizations, associations, and businesses to more broadly ensure
their access to, and understanding of, pandemic preparation tools,
resources, and guidance.
While this guidance has been useful to our stakeholders, challenges
arose because the H1N1 virus presented itself in a way that differed
from some assumptions made in previous pandemic flu planning materials.
Because of this, DHS and the Centers for Disease Control and Prevention
(CDC) continue to work together to provide updated guidance that can
best help CIKR and private sector partners maintain operations through
the trials of a pandemic influenza.
For example, our CIKR and Private Sector Offices are jointly
participating in outreach with CDC, bringing together representatives
from several major international corporations. The initial workshop
focused on efforts to help private sector partners better prepare to
meet their essential functions in a pandemic environment. Additional
outreach is planned by both the National Protection and Programs
Directorate and the Private Sector Office.
Furthermore, to anticipate the impact of H1N1 on critical
infrastructure and private sector businesses and organizations, the DHS
National Biosurveillance Integration Center has partnered with the
National Infrastructure Simulation and Analysis Center within the DHS
Office of Infrastructure Protection to present mathematical modeling of
the virus' expected spread and infrastructure impact informed by the
best available epidemiological information about the virus. We will use
this data to help guide our policy decisions as well as our
preparedness and planning activities.
protecting the dhs workforce
As I mentioned earlier, DHS had personal protective equipment on
hand for use by employees, specifically those who perform certain tasks
that may place them at increased risk of exposure. Components with
employees who may be at risk include the U.S. Coast Guard (USCG), U.S.
Immigration and Customs Enforcement (ICE), U.S. Customs and Border
Protection (CBP), and the Transportation Security Administration (TSA).
For example, TSA has shipped PPE to every airport hub, to Federal Air
Marshal Special Agent in Charge offices, and to Office of Inspection
field locations. Additionally, PPE is pre-positioned at 120 DHS
locations and field offices Nation-wide.
The Department has also stockpiled two types of antivirals,
oseltamivir (Tamiflu) and zanamivir (Relenza), dedicated to DHS
workforce protection. These medications are stored in a pharmaceutical
warehouse, fielded across the Operational Workforce sites, and are
prepared to be deployed as necessary. In addition, the USCG purchased
courses of antivirals through Department of Defense stockpile channels.
Overall, DHS has on hand approximately 540,000 courses of antivirals
targeted for its mission-essential workforce.
The health and safety of our workforce is one of Secretary
Napolitano's and my top priorities, and we will continue to ensure that
our front-line employees receive workforce protection guidance based on
the best science available. DHS follows CDC guidance and OSHA standards
on personal protective equipment, including when to use masks and
respirators, and updates that guidance as new guidance is released. We
learned from the H1N1 flu emergence that we needed to have more
guidance in place. Looking forward, we are involved in intra-agency and
interagency efforts to develop coordinated workforce protection
guidance. There is no question that this continues to be a priority
area for DHS.
other current and on-going h1n1 activities
The Department will continue to conduct stakeholder outreach,
strategize and plan, and work with our interagency partners to help the
Nation become as prepared as possible for any future pandemic.
Additional on-going activities of DHS offices and components include
the following:
OHA is working with the CDC, HHS, and the Department of
Veterans Affairs on guidance to Federal departments on
prioritizing their employees for vaccines as well as on vaccine
distribution strategies for Federal employees.
OHA continues to stockpile antivirals and PPE. OHA is also
developing policies and guidance for the use of antivirals and
PPE by DHS employees, based on CDC guidance, as well as working
with all components on communication programs, education, and
training in order to protect our workforce.
The Office of Public Affairs is working with the White
House, HHS, and other agencies on overall pandemic
communication strategies.
The Regional Coordination Teams are beginning training and
outreach to State and local officials.
Department leadership, under my supervision, meets weekly to
review key preparedness timelines and strategies, identify
gaps, and design solutions.
FEMA, in coordination with HHS, has drafted a Comprehensive
Preparedness Guide (CPG) specifically for pandemic influenza.
This CPG will be published in the next few weeks to provide
operational direction to State, local, and Tribal jurisdictions
relating to their pandemic planning.
NBIC is maintaining constant, real-time, dynamic
biosurveillance.
The NOC is coordinating efforts that will allow the U.S.
Government to maintain a common operating picture of the
current status of H1N1 influenza outbreaks during the fall
waves.
Again, thank you for the invitation to discuss these important
issues and for your continued willingness to work alongside the
Department to provide leadership in protecting and ensuring the
security of our homeland.
Chairman Thompson. Thank you for your testimony.
I now recognize Deputy Secretary Corr to summarize his
statement for 5 minutes.
STATEMENT OF WILLIAM CORR, DEPUTY SECRETARY, DEPARTMENT OF
HEALTH AND HUMAN SERVICES
Mr. Corr. Thank you, Mr. Chairman, Congressman King, and
Members of the committee, it is a pleasure to be here today to
give you an update on the activities of the Department of
Health and Human Services. It is certainly a pleasure to appear
with Deputy Secretary Lute, my colleague with DHS, and
certainly with Ms. Steinhardt, we have great respect for the
work that GAO does and take it very, very seriously.
Secretary Sebelius and all of us at HHS deeply appreciate
the leadership that the Congress has shown in providing the
resources in the supplemental appropriations bill to give us
the flexibility to begin targeting our resources as we need to
for this H1N1 outbreak.
While the headlines and the 24-hour news updates may have
quieted down, this virus has not gone away and we cannot let up
for one moment. In concert with our partners at Homeland
Security and throughout the administration, we are doing
everything possible to monitor and respond to this virus. The
Department's concentrated and considerable efforts are not
about raising alarms, they are about being being prepared. This
is a very serious virus capable of causing severe disease and
death, and it is essential that we have a coordinated and clear
strategy to combat it.
Going forward, we will work closely with the White House,
with the Department of Homeland Security, and all of our
Federal interagency partners to focus our health efforts around
four areas.
First is surveillance, to learn as much as we can about the
virus, how it is changing and how it is spreading.
Second, mitigation to encourage people to do what they can
do. Each citizen has things that they can do in home and in
their schools and their neighborhoods, to deal with the
potential surge on our medical infrastructure, and to provide
appropriate medical countermeasures.
Immunization is the third leg which involves laying the
groundwork for a potentially large-scale campaign to distribute
vaccine.
Last is communication, providing clear and accurate
information to State and local governments and to the public.
I would like to, Mr. Chairman, very quickly try to
summarize some of the main activities. There are many, but I
will highlight them and then be available for any questions
that the committee might ask.
As noted, the virus has now reached every State in the
United States. As of July 24, there were over 43,000 confirmed
cases; 5,000 hospitalizations; and 302 deaths. Going forward,
CDC will be reporting in a different way, reporting on the
number of hospitalizations and deaths and a good deal of
information about the virus itself, how we are tracking it,
where the flu is occurring and what the impact is on disease
and on hospitalization.
This virus usually causes a self-limited disease that gets
better without treatment, but it also can cause severe illness
and even death. Infants, children, and those with underlying
health conditions appear to be most vulnerable to severe
disease.
The CDC is working closely with the World Health
Organization and the Pan American Health Organization and
ministries of health from around the world to continue
characterizing the virus as it spreads. To today, we have
observed rapid, early season increases in flu cases in the
southern hemisphere, evidence of increased burden on the health
care system, and extended school closures in some locations. We
are working aggressively to monitor for evidence of change in
the virus and whether it is becoming more virulent and
transmittal.
All of this information will allow us to make decisions as
we go forward here in the United States.
On May 22, Secretary Sebelius announced $1.1 billion of
funds for vaccine development and manufacturing that includes
clinical trials that will give us further information about
safety and the optimal dose that is needed for the protective
immune response that we desire. She also has announced $884
million to secure ingredients, including the antigens which are
the key components of vaccine and adjuvant so that we will have
vaccine available, if needed.
The studies are underway now with the vaccine, and we
anticipate limited quantities of the vaccine in the next
several months. Today, a special meeting of the CDC's advisory
committee on immunization practices is occurring, and they will
be considering many subjects and are one of our many advisory
committees that we are relying upon for scientific and public
health expertise.
One of the recommendations will be on the age and risk
groups that are recommended for vaccination. To help
communities prepare for an increase in cases this fall, HHS,
Homeland Security, and the Department of Education conducted a
summit on July 9 involving State, local, Tribal, and Federal
officials to discuss lessons learned, best practices, and to
discuss preparedness priorities. At the summit, Secretary
Sebelius announced the availability of $350 million in
supplemental funding that will be made available both to State,
local, and territorial health departments as well as to
hospitals for preparedness.
At the summit, we sent a strong message to our partners
that they must be ready to begin an immunization program this
fall when the licensed vaccine is anticipated to be available,
but the decision to do a vaccination program has not been made
yet and will be made in the near future.
Before an immunization campaign begins, our scientific and
public health experts will learn everything we can about the
vaccine, its safety and efficacy, as well as the status of the
spread of the virus as we make decisions. We have also
purchased antivirals and other needed products. We have begun
our effort to educate the public as, Congressman King pointed
out, and I know that all of the Members of the committee are
deeply concerned about so that the public has as much
information as possible on how they can protect themselves.
We have provided some school guidance, and will be
providing extensive guidance to schools about how they should
consider their activities as they enter into the school year.
We are working with Federal, State, local, and Tribal
partners to develop a community-based set of interventions. Mr.
Chairman, if I may say in closing, we will also make every
endeavor to keep this committee and other key committees of the
Congress fully informed about our actions, what we know, as
well as what we do not know. Thank you, Mr. Chairman.
[The statement of Mr. Corr follows:]
Prepared Statement of William Corr
July 29, 2009
Good afternoon Chairman Thompson, Ranking Member King, and Members
of the committee. I am Bill Corr, Deputy Secretary at the U.S.
Department of Health and Human Services (HHS). I am pleased to have
this opportunity to update the committee on HHS' activities related to
the 2009-H1N1 influenza outbreak. Several HHS agencies, including the
Office of the Assistant Secretary for Preparedness and Response (ASPR),
the Centers for Disease Control and Prevention (CDC), the National
Institutes of Health (NIH) and the Food and Drug Administration (FDA),
play key roles in our preparations for and response to pandemic
influenza.
We appreciate the quick action of Congress in recently providing
$1.85 billion in immediately available resources and an additional $5.8
billion contingency emergency appropriation for pandemic influenza
preparedness and response, of which we have notified you that we plan
to immediately access $1.825 billion. The Congress has provided
sufficient flexibility within the appropriation for HHS to target its
responses and resources as the situation evolves. Immediate activities
will include providing funding to States for important planning
necessary if a 2009-H1N1 immunization program is implemented this fall;
funding to hospitals for preparation activities given a likely surge in
patients during the flu season; purchasing additional vaccines,
syringes, and needles; and providing support for monitoring,
diagnostics, and public health response capabilities.
Mr. Chairman, we at the Department are proud of what we've done so
far to protect the American people. While the headlines and 24-hour
news updates may have quieted down, this virus has not gone away, and
we have not let up. In concert with our partners at the Department of
Homeland Security and throughout the administration, we are doing
everything possible to monitor and respond to this virus.
It has been our goal to build the national infrastructure necessary
to mount a scalable and flexible response to a novel influenza virus.
This has included developing pre-pandemic vaccines for viruses with
pandemic potential; Federal and State stockpiling of key medical
countermeasures, such as antiviral drugs; and conducting exercises to
practice accessing and distributing materiel from the stockpiles.
With the strong support of Congress, and working with Governors,
mayors, Tribes, State and local health departments, the medical
community, and our private sector partners, the administration has been
actively building on the preparations that have been underway for
several years for an anticipated influenza pandemic to ensure the
Nation is ready for the H1N1 virus scenarios that may develop over the
next few months. From the outset, we have said that medical science
will lead the way, and we are preparing action plans based on the best
scientific information available.
I want to be clear: The Department's efforts are not about raising
alarms or stoking fears. They are about being prepared. This is a
serious virus capable of causing severe disease and death, and it is
essential that we have a clear and coordinated strategy to combat it.
With that in mind, HHS is currently working with the White House
and our Federal interagency partners to focus and galvanize our efforts
around a National Framework for 2009-H1N1 Influenza Preparedness and
Response that is based on four pillars: Surveillance, mitigation,
immunization, and communication.
Surveillance entails learning as much as we can about whether and
how the virus is changing and spreading in the rest of the world, so
that we have a clearer idea of how the virus will present in the United
States during the fall flu season. Mitigation means encouraging people
to do basic things at work, at home, in schools, and in their
neighborhoods to help stop the spread of the virus; managing a
potential surge in demands on our medical infrastructure; and providing
appropriate medical countermeasures to infection. Immunization involves
laying the groundwork for a potentially large-scale campaign to
distribute an H1N1 vaccine and prioritize its use. And communication
means providing clear and accurate information to State and local
governments and to the public, which is essential during an outbreak.
Each of the efforts I will describe this morning fits into this
framework.
Since the first 2009-H1N1 influenza patient in the United States
was confirmed by laboratory testing at CDC on April 15, 2009, the virus
has reached every State in the United States. On April 26, 2009 HHS
issued a Nation-wide Public Health Emergency Declaration and declared
that the emergency justified emergency use of several products. On that
and the following day FDA issued four Emergency Use Authorizations
(EUAs) in response to requests by CDC. An EUA allows the use of an
unapproved product or use of an approved product for an unapproved use
in an emergency declared as justifying such use. These authorizations
allowed for the emergency use of certain antiviral medications, in
vitro diagnostic devices, and respiratory protection products. A fifth
EUA for a diagnostic panel for laboratory screening followed.
As of July 24, 2009 CDC reported 43,771 confirmed and probable
cases in the United States, with 5,011 hospitalizations and 302 deaths.
However, most cases are not tested and confirmed and CDC estimates that
there have been more than 1 million cases of novel H1N1 flu in the
United States to date. Since the exact number of persons ill with 2009-
H1N1 flu is likely to be much higher than individual case counts
indicate, Friday, July 24, 2009, was the last day that CDC is providing
individual confirmed and probable cases of novel H1N1 influenza. CDC
will continue to report the total number of hospitalizations and deaths
each week, and to use its traditional surveillance systems to track the
progress of the novel H1N1 flu outbreak. These systems work to
determine when and where flu activity is occurring, track flu-related
illness, determine what flu viruses are circulating, detect changes in
flu viruses and measure the impact of flu on hospitalizations and
deaths in the United States. The World Health Organization (WHO)
reported 94,512 confirmed cases on July 6, 2009. For similar reasons,
earlier in July the World Health Organization announced that it would
stop issuing its global tables showing the numbers of confirmed novel
H1N1 flu cases for all countries.
This virus usually causes a self-limited disease that gets better
without treatment, but it can also cause severe illness and even death.
Infants, children, and those with underlying health conditions appear
to be most vulnerable to severe disease.
CDC staff worldwide are collaborating with WHO, the Pan American
Health Organization (PAHO) and ministries of health to study
characteristics of the 2009-H1N1 virus, including: The severity and
transmissibility of H1N1 illness; population-based rates of mild and
severe illness; risk factors for severe disease; impact on the health
care infrastructure; and rates of transmission in households and
communities in the Southern Hemisphere. These activities will better
prepare the Nation and other Northern Hemisphere countries when we
enter flu season in the fall.
To date, we have observed rapid early season increase in flu cases
in the Southern Hemisphere, evidence of increased burden on health care
systems and extended school closures in several locations. We also are
working aggressively to monitor for evidence of changes in the 2009-
H1N1 virus itself, whether the virus is becoming more virulent or
transmittable.
Efforts are underway to develop a vaccine against this new virus.
NIH plans to invest more than $200 million in influenza research,
including research on the 2009-H1N1, this fiscal year. Over the years,
NIH has built a substantial infrastructure of research centers,
intramural and NIH-supported extramural laboratories, highly trained
personnel, and clinical research networks to rapidly conduct research
on new pandemic viruses, such as 2009-H1N1 influenza. This established
infrastructure enabled intramural researchers on the NIH campus,
researchers at medical centers throughout the country in pre-existing
NIH research networks, such as the Centers of Excellence in Influenza
Research and Surveillance (CEIRS) and Regional Centers of Excellence
for Biodefense and Emerging Infectious Diseases (RCEs), as well as
industry partners and individual NIH grantees to act quickly to study
the 2009-H1N1 influenza virus. In addition, NIH has been working with
the biotechnology and pharmaceutical industries to speed development of
new influenza vaccines, diagnostic tools, and anti-influenza drugs.
On May 22, 2009 HHS Secretary Sebelius announced that $1.1 billion
of funds previously appropriated for such purposes would be used for
vaccine development and manufacturing. This includes resources for the
clinical trials that are being carried out through NIH and through the
manufacturers in collaboration with the FDA, CDC, and ASPR. On July 13,
Secretary Sebelius announced that the Department will commit an
additional $884 million to secure additional ingredients, including
antigens and adjuvants, needed to manufacture the H1N1 vaccines. The
Biomedical Advanced Research and Development Authority (BARDA) within
ASPR has contracted with five vaccine manufacturers for the purchase of
these bulk vaccine components. In addition to clinical trials conducted
by the manufacturers, NIH will use its longstanding vaccine clinical
trials infrastructure, notably the network of Vaccine and Treatment
Evaluation Units, to conduct clinical studies to confirm safety and
determine the optimal dose needed to induce a protective immune
response. The five manufacturers who already produce U.S.-licensed
seasonal vaccine are also conducting their own 2009-H1N1 influenza
vaccine trials under contract with HHS. These studies are just
beginning to get under way and will be carried out over the next
several months. We anticipate that limited quantities of a vaccine may
be available by mid-October.
NIH and its industry partners have been developing several other
kinds of influenza vaccines, for example, DNA vaccines, in which
harmless influenza genetic sequences are injected directly into a
person to stimulate an immune response against the proteins coded for
by these genetic sequences. Studies are underway to evaluate how well
these candidate antiviral drugs block the 2009-H1N1 influenza strain
and to screen other compounds for activity against the virus. However,
because these ``next-generation'' vaccines will require additional
safety and efficacy testing before they can be deployed, they are
unlikely to reach the public before the vaccines that are currently
being produced.
Today a special meeting of CDC's Advisory Committee on Immunization
Practices (ACIP) will take place in Atlanta to follow up on issues
related to planning for a 2009-H1N1 immunization campaign should it
become necessary. Meeting topics include 2009-H1N1 epidemiology in the
United States and internationally; implementation planning; vaccine
development and formulations; communications; and ACIP Workgroup
recommendations on age/risk groups recommended for vaccination.
To help communities prepare for an increase in 2009-H1N1 influenza
cases in the fall, HHS, the Department of Homeland Security, the
Department of Education and the White House held the H1N1 Influenza
Preparedness Summit at NIH on July 9, 2009 for Federal, State, local,
and Tribal officials to build on and tailor States' existing pandemic
plans, share lessons learned and best practices, and discuss
preparedness priorities.
At the summit, Secretary Sebelius announced the availability of
$350 million in supplemental funding. These funds will be available to
State, local, and territorial health departments to bolster their
response activities to the 2009-H1N1 influenza pandemic, including:
Addressing planning gaps; preparing for a potential mass vaccination
campaign; meeting the information needs of the public, health, and
educational professionals to support their decision-making;
implementing strategies to reduce people's exposure to the 2009-H1N1
virus; supporting laboratory testing; preparing hospitals and the
health care community; and improving influenza surveillance and
investigations.
At the summit we sent a strong message to our State, tribal, and
local partners that they must be ready to begin an immunization program
by mid-October, when the first licensed vaccine is anticipated to be
available. Before an immunization campaign begins, we will review what
we know about the vaccine, its safety and efficacy, as well as the
status of the pandemic to determine if an immunization program should
proceed.
Vaccines are not the only tools we have in our response
armamentarium. Other 2009-H1N1 response efforts include the use of
antiviral drugs and mitigation efforts, such as social distancing.
The 2009-H1N1 influenza virus is currently sensitive to the
antiviral drugs oseltamivir (Tamiflu) and zanamivir (Relenza).
(Although cases of resistance to oseltamivir have been detected in some
2009-H1N1 virus isolates, they are currently rare.) When it became
apparent that 2009-H1N1 was spreading within the United States, HHS
released 25 percent of the States' pro rata share of antiviral drugs
and personal protective equipment. to help the States prepare to
respond to the outbreak. Thirteen million regimens of antiviral drugs
have been purchased and are scheduled to be delivered to replenish the
CDC's Strategic National Stockpile (SNS) by the end of September 2009.
An additional 400,000 regimens of antiviral drugs from the SNS were
delivered to Mexico in response to an official request for assistance
in combating the 2009-H1N1 influenza outbreak. Additionally, HHS
recently announced plans to provide 420,000 treatment courses of
oseltamavir to PAHO to fight the 2009-H1N1 virus in Latin America and
the Caribbean.
CDC and other HHS agencies continue to educate the public on ways
to prevent infection, including frequent hand washing, staying home
from school or work if ill, and coughing and sneezing into your elbow
instead of your hands.
School guidance is an area of particular concern because children
are one of the groups at greatest risk of illness with this particular
strain of influenza and are transmitting the virus at high rates. HHS
is working with Federal, State, local, and Tribal partners to develop a
comprehensive public health guidance package to inform decisions about
a range of interventions applicable to school settings. Our goal, if
possible, is to keep schools open and safe for students, faculty, and
staff, but we will also advise communities to be prepared for the
possibility of school closures, particularly if the virus were to
change or become more severe. It will include decision-making guidance
about how to choose combinations of interventions most applicable to
the local situation and acceptable to the community.
HHS is also working with Federal, State, local, and Tribal partners
to develop a more general set of community-based interventions
applicable in a wide range of settings. HHS will develop tools and
materials to make the recommendations specific to various settings, and
is establishing a technical assistance cadre to provide one-on-one
consulting.
To assist in preparing communities for increased health care
demand, HHS is increasing the level of engagement with health care
providers by convening stakeholder meetings to develop guidance and/or
tools; providing tools and templates for local community planners;
facilitating or supporting the development of clinical and triage
protocols; and providing other technical assistance to partners and
Federal agencies.
Additionally, HHS will continue to evaluate community mitigation
guidelines. As the outbreak progresses, we will continue to assess all
guidelines to ensure that they are appropriately based upon the
available science.
Please be assured that we will continue to communicate with you. We
will tell you what we know when we know it, and we will also inform you
when we don't know. To that end, we continue to work with our State,
local, territorial, and Tribal partners to best prepare our communities
to respond effectively to the formidable public health and medical
challenge that 2009-H1N1 influenza presents to us all.
I would like to conclude by making two important points. First, we
are all in this together. While the steps the Department and other
agencies have taken will help engage the American people and ensure
they are prepared, it's important for every family, business, and
school to prepare its own household and business plan and think through
the steps they will take if a family member, co-worker, or student
contracts the H1N1 flu. This is a responsibility that we all share as
parents, neighbors, co-workers, and community members.
The second point is that, while the H1N1 pandemic presents a
tremendous challenge, it has also brought a valuable opportunity that
has helped us accelerate our work to improve the entire public health
system; raise awareness about the basic steps people can take to stop
the spread of germs and disease and the value of seasonal flu vaccine;
and identify the strengths and weaknesses in our prevention and
preparedness systems. The application of these lessons will be
invaluable.
We have made tremendous progress over the years in preparing for a
flu pandemic. Congress has provided strong leadership and support for
these efforts. We look forward to working with you to continue the
progress we have made to ensure that our Nation is prepared for any
public health threat.
I would be happy to answer any questions.
Chairman Thompson. Thank you for your testimony. We will
get into some of the meat of it after opening statements.
I now recognize Director Steinhardt to summarize her
statement for 5 minutes.
STATEMENT OF BERNICE STEINHARDT, DIRECTOR, STRATEGIC ISSUES,
GOVERNMENT ACCOUNTABILITY OFFICE
Ms. Steinhardt. Thank you, Mr. Chairman, Mr. King, and
other Members of the committee. We appreciate the opportunity
to be here today to talk about the work that we have done at
your request over the last 3 years, to assess the Federal
Government's planning and preparedness for a pandemic
influenza. When we started, a pandemic was a possibility.
Today, it is a reality. As it has turned out, we have been
fortunate so far that the pandemic has not been severe. The big
question that we face is whether it will stay that way or
whether the virus will become more virulent this fall or
winter. In any case, we know we have to be prepared for that.
So how well-prepared are we? Clearly we are benefiting from
the groundwork that has been laid over the last few years. We
have a National pandemic strategy and implementation plan
developed by the Federal Government. All 50 States and the
District of Columbia, as well as many local governments and
private companies have their own pandemic plans as well. But
the work we have done suggests that there is more that the
Federal Government can and should do to fill in the gaps in the
Nation's readiness.
This afternoon I would like to focus on the most important
of these gaps that our work has shown.
First, the leadership roles in the pandemic, the who-is-in-
charge question, have not been clearly worked out and tested,
as you pointed out earlier, Mr. Chairman. Under the National
plan, the Secretaries of Homeland Security and Health and Human
Services are supposed to share leadership responsibilities
along with the system of Federal coordinating officials,
principal Federal officials, and the FEMA administrator. But
there has never been a National exercise to test how these
roles will work together, a point of particular importance now
that we have new leaders in these positions. In 2007, we
recommended that the two Departments undertake this kind of
exercise, but that has not been done.
Second, the National plan, which was intended to be a 3-
year plan, is now over 3 years old and it needs to be updated,
particularly in light of the experiences of the last few
months. But there are no provisions for updating the plan or
even reporting on its progress. Two years ago we recommended
that the Homeland Security Council establish a process for
updating the plan that would also involve key stakeholders,
like State and local governments, and would incorporate lessons
learned from exercises and other sources. That still has not
been acted on.
Third, the Federal Government could be doing a better job
of sharing its expertise and coordinating its decisions with
other levels of government and the private sector. There have
been a number of mechanisms developed for this purpose, but
they could be used even more. The critical infrastructure
coordinating councils, for example, bring together private
sector leaders from the 18 critical infrastructure sectors with
officials from DHS and other Federal and State agencies to
develop plans to protect critical infrastructure in major
emergencies, including a pandemic flu.
But at the time of our 2007 review, private sector members
told us they were still looking for clarification about the
respective roles and responsibilities of the Federal and State
governments in areas like State border closures and vaccine
distribution. We recommended then that DHS make greater use of
the coordinating councils to have these kinds of discussions
and help resolve some of these issues, but it is not clear to
us that this has been happening.
Finally, there needs to be a greater degree of
accountability to ensure that Federal workers are protected in
the event of a pandemic.
Under the National pandemic plan, agencies are supposed to
develop operational plans to protect their employees and to
maintain essential operations and services. But based on our
survey of the major agencies, progress on these plans appear to
be very uneven with several agencies reporting that they were
still in the early stages of planning. Yet there is no
mechanism to monitor agency planning and no provision for
agencies to report on their progress. As a result, we
recommended that the Homeland Security Council ask DHS to take
on this monitoring and reporting role, and we suggested that
the Congress might want to consider requiring DHS to report to
the Congress as well as to the White House.
In closing, I want to observe that the last few months have
given us real-life experience with some of the issues that are
raised by a pandemic flu, but all of this experience will be
for naught if we don't incorporate its lessons into our
planning for the future. As our work suggests, there are still
significant gaps and we should be addressing them now while
time is still on our side.
Thank you very much.
[The statement of Ms. Steinhardt follows:]
Prepared Statement of Statement of Bernice Steinhardt
July 29, 2009
gao highlights
Highlights of GAO-09-909T, a testimony before the Committee on
Homeland Security, House of Representatives.
Why GAO Did This Study
As the current H1N1 outbreak underscores, an influenza pandemic
remains a real threat to our Nation. Over the past 3 years, GAO
conducted a body of work, consisting of 12 reports and 4 testimonies,
to help the Nation better prepare for a possible pandemic. In February
2009, GAO synthesized the results of most of this work and, in June
2009, GAO issued an additional report on agency accountability for
protecting the Federal workforce in the event of a pandemic. GAO's work
points out that while a number of actions have been taken to plan for a
pandemic, including developing a national strategy and implementation
plan, many gaps in pandemic planning and preparedness still remain.
This statement covers six thematic areas: (1) Leadership,
authority, and coordination; (2) detecting threats and managing risks;
(3) planning, training, and exercising; (4) capacity to respond and
recover; (5) information sharing and communication; and (6) performance
and accountability.
What GAO Recommends
This statement discusses the status of GAO's prior recommendations
on the Nation's planning and preparedness for a pandemic. Key open
recommendations concern the need to exercise the shared Federal
leadership roles for a pandemic, address planning gaps at all levels of
government and in the private sector, and monitor and report on
agencies' plans to protect their workers.
influenza pandemic.--gaps in pandemic planning and preparedness need to
be addressed
What GAO Found
Leadership roles and responsibilities for an influenza
pandemic need to be clarified, tested, and exercised, and
existing coordination mechanisms, such as critical
infrastructure coordinating councils, could be better utilized
to address challenges in coordination between the Federal,
State, and local governments and the private sector in
preparing for a pandemic.
Efforts are underway to improve the surveillance and
detection of pandemic-related threats, but targeting assistance
to countries at the greatest risk has been based on incomplete
information, particularly from developing countries.
Pandemic planning and exercising has occurred at the
Federal, State, and local government levels, but important
planning gaps remain at all levels of government. At the
Federal level, agency planning to maintain essential operations
and services while protecting their employees in the event of a
pandemic is uneven.
Further actions are needed to address the capacity to
respond to and recover from an influenza pandemic, which will
require additional capacity in patient treatment space, and the
acquisition and distribution of medical and other critical
supplies, such as antivirals and vaccines.
Federal agencies have provided considerable guidance and
pandemic-related information to State and local governments,
but could augment their efforts with additional information on
school closures, State border closures, and other topics.
Performance monitoring and accountability for pandemic
preparedness needs strengthening. For example, the May 2006
National Strategy for Pandemic Influenza Implementation Plan
does not establish priorities among its 324 action items and
does not provide information on the financial resources needed
to implement them. Also, greater agency accountability is
needed to protect Federal workers in the event of a pandemic
because there is no mechanism in place to monitor and report on
agencies' progress in developing workforce pandemic plans.
The current H1N1 pandemic should serve as a powerful reminder that
the threat of a pandemic influenza, which seemed to fade from public
awareness in recent years, never really disappeared. While Federal
agencies have taken action on 13 of GAO's 24 recommendations, 11 of the
recommendations that GAO has made over the past 3 years have not been
fully implemented. With the possibility that the H1N1 virus could
become more virulent this fall or winter, the administration and
Federal agencies should use this time to turn their attention to
filling in the planning and preparedness gaps GAO's work has pointed
out.
Mr. Chairman and Members of the committee: I am pleased to be here
today to discuss key themes from the body of work GAO has developed
over the past several years to help the Nation better prepare for,
respond to, and recover from a possible influenza pandemic. An
influenza pandemic remains a real threat to our Nation and to the
world, as we are witnessing during the current H1N1 pandemic. The
previous administration took a number of actions to plan for a
pandemic, including developing a national strategy and implementation
plan. However, much more needs to be done, and many gaps in planning
and preparedness still remain. Strengthening preparedness for large-
scale public health emergencies, such as an influenza pandemic, is one
of 13 urgent issues that we identified earlier this year as among those
needing the immediate attention of the new administration and
Congress.\1\
---------------------------------------------------------------------------
\1\ GAO's 2009 Congressional and Presidential Transition website:
http://www.gao.gov/transition_2009.
---------------------------------------------------------------------------
In the past 3 years, GAO has issued 12 reports and 4 testimonies on
influenza pandemic planning.\2\ We synthesized the results of most of
our work in a February 2009 report, which I will discuss in more detail
today.\3\ In addition, I will discuss key results from our recent
report on protecting the Federal workforce in the event of a
pandemic.\4\ We have made 24 recommendations based on the findings from
these reports, 13 of which have been acted upon by the responsible
Federal agencies. The responsible Federal agencies have generally
agreed with our recommendations and some actions are underway to
address them. However, 11 recommendations have not yet been fully
implemented. While our February 2009 report made no new
recommendations, it reflects the status of those recommendations that
were made prior to our June 2009 report that had not yet been
implemented. Many of the recommendations that remain unimplemented have
become even more pressing in light of the very real possibility of the
return of a more severe form of the H1N1 virus later this year. Lists
of our open recommendations and related GAO products that are
referenced throughout this statement are located in attachments I and
II.*
---------------------------------------------------------------------------
\2\ We also have two pandemic-related reviews underway on the
following topics: (1) The status of implementing the National Strategy
for Pandemic Influenza Implementation Plan (National Pandemic
Implementation Plan); and (2) the effect of a pandemic on the
telecommunications capacity needed to sustain critical financial market
activities.
\3\ GAO, Influenza Pandemic: Sustaining Focus on the Nation's
Planning and Preparedness Efforts, GAO-09-334 (Washington, DC: Feb. 26,
2009).
\4\ GAO, Influenza Pandemic: Increased Agency Accountability Could
Help Protect Federal Employees Serving the Public in the Event of a
Pandemic, GAO-09-404 (Washington, DC: June 12, 2009).
* The information has been retained in committee files.
---------------------------------------------------------------------------
In summary, my statement will address the following issues which
were drawn from the key themes of GAO's pandemic work:
Leadership roles and responsibilities for an influenza
pandemic need to be clarified, tested, and exercised, and
existing coordination mechanisms, such as critical
infrastructure coordinating councils, could be better utilized
to address challenges in coordination between the Federal,
State, and local governments and the private sector in
preparing for a pandemic.
Efforts are underway to improve the surveillance and
detection of pandemic-related threats in humans and animals,
but targeting assistance to countries at the greatest risk has
been based on incomplete information, particularly from
developing countries.
Pandemic planning and exercising have occurred at the
Federal, State, and local government levels, but important
planning gaps remain at all levels of government. At the
Federal level, agency planning to maintain essential operations
and services while protecting their employees in the event of a
pandemic is uneven.
Further actions are needed to address the capacity to
respond to and recover from an influenza pandemic, which will
require additional capacity in patient treatment space, and the
acquisition and distribution of medical and other critical
supplies, such as antivirals and vaccines.
Federal agencies have provided considerable guidance and
pandemic-related information to State and local governments,
but could augment their efforts with additional information on
school closures, State border closures, and other topics.
Performance monitoring and accountability for pandemic
preparedness needs strengthening. For example, the May 2006
National Strategy for Pandemic Influenza Implementation Plan
(National Pandemic Implementation Plan) does not establish
priorities among its 324 action items and does not provide
information on the financial resources needed to implement
them. Also, greater agency accountability is needed to protect
Federal workers in the event of a pandemic because there is no
mechanism in place to monitor and report on agencies' progress
in developing workforce pandemic plans that provide the
operational details of how agencies will protect their
employees and maintain essential operations and services.
As noted earlier, this statement is based on our prior work, which
was conducted in accordance with generally accepted government auditing
standards. Those standards require that we plan and perform the audit
to obtain sufficient, appropriate evidence to provide a reasonable
basis for our findings and conclusions based on our audit objectives.
We believe that the evidence obtained provides a reasonable basis for
our findings and conclusions based on our audit objectives.
background
Given the consequences of a severe influenza pandemic, in 2006, GAO
developed a strategy for our work that would help support Congress's
decision-making and oversight related to pandemic planning. Our
strategy was built on a large body of work spanning two decades,
including reviews of Government responses to prior disasters such as
Hurricanes Andrew and Katrina, the devastation caused by the
9/11 terror attacks, efforts to address the Year 2000 (Y2K) computer
challenges, and assessments of public health capacities in the face of
bioterrorism and emerging infectious diseases such as Severe Acute
Respiratory Syndrome (SARS). The strategy was built around six key
themes as shown in figure 1. While all of these themes are
interrelated, our earlier work underscored the importance of
leadership, authority, and coordination, a theme that touches on all
aspects of preparing for, responding to, and recovering from an
influenza pandemic.
[GRAPHIC(S)] [NOT AVAILABLE IN TIFF FORMAT]
Influenza pandemic--caused by a novel strain of influenza virus for
which there is little resistance and which therefore is highly
transmissible among humans--continues to be a real and significant
threat facing the United States and the world. Unlike incidents that
are discretely bounded in space or time (e.g., most natural or man-made
disasters), an influenza pandemic is not a singular event, but is
likely to come in waves, each lasting weeks or months, and pass through
communities of all sizes across the Nation and the world
simultaneously. However, the current H1N1 pandemic seems to be
relatively mild, although widespread. The history of an influenza
pandemic suggests it could return in a second wave this fall or winter
in a more virulent form.\5\ While a pandemic will not directly damage
physical infrastructure such as power lines or computer systems, it
threatens the operation of critical systems by potentially removing the
essential personnel needed to operate them from the workplace for weeks
or months. In a severe pandemic, absences attributable to illnesses,
the need to care for ill family members, and fear of infection may,
according to the Centers for Disease Control and Prevention (CDC),
reach a projected 40 percent during the peak weeks of a community
outbreak, with lower rates of absence during the weeks before and after
the peak.\6\ In addition, an influenza pandemic could result in 200,000
to 2 million deaths in the United States, depending on its severity.
---------------------------------------------------------------------------
\5\ On June 11, 2009, the World Health Organization (WHO) raised
its influenza pandemic alert level from phase 5 to the highest phase,
phase 6, signaling the widespread human infection associated with a
pandemic for the H1N1 virus.
\6\ GAO, Influenza Pandemic: Further Efforts Are Needed to Ensure
Clearer Federal Leadership Roles and an Effective National Strategy,
GAO-07-781 (Washington, DC: Aug. 14, 2007).
---------------------------------------------------------------------------
The President's Homeland Security Council (HSC) took an active
approach to this potential disaster by, among other things, issuing the
National Strategy for Pandemic Influenza (National Pandemic Strategy)
in November 2005, and the National Pandemic Implementation Plan in May
2006.\7\ The National Pandemic Strategy is intended to provide a high-
level overview of the approach that the Federal Government will take to
prepare for and respond to an influenza pandemic. It also provides
expectations for non-Federal entities--including State, local, and
tribal governments; the private sector; international partners; and
individuals--to prepare themselves and their communities. The National
Pandemic Implementation Plan is intended to lay out broad
implementation requirements and responsibilities among the appropriate
Federal agencies and clearly define expectations for non-Federal
entities. The Plan contains 324 action items related to these
requirements, responsibilities, and expectations, most of which were to
be completed before or by May 2009. HSC publicly reported on the status
of the action items that were to be completed by 6 months, 1 year, and
2 years in December 2006, July 2007, and October 2008 respectively. HSC
indicated in its October 2008 progress report that 75 percent of the
action items have been completed. We have on-going work for this
committee assessing the status of implementing this plan which we
expect to report on in the fall of 2009.
---------------------------------------------------------------------------
\7\ On May 26, 2009, the President announced the full integration
of White House staff supporting national security and homeland
security. The Homeland Security Council will be maintained as the
principal venue for interagency deliberations on issues that affect the
security of the homeland, such as influenza pandemic.
---------------------------------------------------------------------------
leadership roles and responsibilities need to be clarified and tested,
and coordination mechanisms could be better utilized
Federal Government leadership roles and responsibilities for
pandemic preparedness and response are evolving, and will require
further testing before the relationships among the many Federal
leadership positions are well understood. Such clarity in leadership is
even more crucial now, given the change in administration and the
associated transition of senior Federal officials. Most of these
Federal leadership roles involve shared responsibilities between the
Department of Health and Human Services (HHS) and the Department of
Homeland Security (DHS), and it is not clear how these would work in
practice. According to the National Pandemic Strategy and Plan, the
Secretary of Health and Human Services is to lead the Federal medical
response to a pandemic, and the Secretary of Homeland Security will
lead the overall domestic incident management and Federal coordination.
In addition, under the Post-Katrina Emergency Management Reform Act of
2006, the Administrator of the Federal Emergency Management Agency
(FEMA) was designated as the principal domestic emergency management
advisor to the President, the HSC, and the Secretary of Homeland
Security, adding further complexity to the leadership structure in the
case of a pandemic.\8\ To assist in planning and coordinating efforts
to respond to a pandemic, in December 2006 the Secretary of Homeland
Security predesignated a national Principal Federal Official (PFO) for
influenza pandemic and established five pandemic regions each with a
regional PFO and Federal Coordinating Officers (FCO) for influenza
pandemic. PFOs are responsible for facilitating Federal domestic
incident planning and coordination, and FCOs are responsible for
coordinating Federal resources support in a presidentially declared
major disaster or emergency.
---------------------------------------------------------------------------
\8\ Pub. L. No. 109-295, Title VI.
---------------------------------------------------------------------------
However, the relationship of these roles to each other as well as
with other leadership roles in a pandemic is unclear. Moreover, as we
testified in July 2007, State and local first responders were still
uncertain about the need for both FCOs and PFOs and how they would work
together in disaster response.\9\ Accordingly, we recommended in our
August 2007 report on Federal leadership roles and the National
Pandemic Strategy that DHS and HHS develop rigorous testing, training,
and exercises for influenza pandemic to ensure that Federal leadership
roles and responsibilities for a pandemic are clearly defined and
understood and that leaders are able to effectively execute shared
responsibilities to address emerging challenges.\10\ In response to our
recommendation, HHS and DHS officials stated in January 2009 that
several influenza pandemic exercises had been conducted since November
2007 that involved both agencies and other Federal officials, but it is
unclear whether these exercises rigorously tested Federal leadership
roles in a pandemic.
---------------------------------------------------------------------------
\9\ GAO, Homeland Security: Observations on DHS and FEMA Efforts to
Prepare for and Respond to Major and Catastrophic Disasters and Address
Related Recommendations and Legislation, GAO-07-1142T (Washington, DC:
July 31, 2007).
\10\ GAO-07-781.
---------------------------------------------------------------------------
In addition to concerns about clarifying Federal roles and
responsibilities for a pandemic and how shared leadership roles would
work in practice, private sector officials told us that they are
unclear about the respective roles and responsibilities of the Federal
and State governments during a pandemic emergency. The National
Pandemic Implementation Plan states that in the event of an influenza
pandemic, the distributed nature and sheer burden of the disease across
the Nation would mean that the Federal Government's support to any
particular community is likely to be limited, with the primary response
to a pandemic coming from States and local communities. Further,
Federal and private sector representatives we interviewed at the time
of our October 2007 report identified several key challenges they face
in coordinating Federal and private sector efforts to protect the
Nation's critical infrastructure in the event of an influenza
pandemic.\11\ One of these was a lack of clarity regarding the roles
and responsibilities of Federal and State governments on issues such as
State border closures and influenza pandemic vaccine distribution.
---------------------------------------------------------------------------
\11\ GAO, Influenza Pandemic: Opportunities Exist to Address
Critical Infrastructure Protection Challenges That Require Federal and
Private Sector Coordination, GAO-08-36 (Washington, DC: Oct. 31, 2007).
---------------------------------------------------------------------------
Coordination Mechanisms
Mechanisms and networks for collaboration and coordination on
pandemic preparedness between Federal and State governments and the
private sector exist, but they could be better utilized. In some
instances, the Federal and private sectors are working together through
a set of coordinating councils, including sector-specific and cross-
sector councils. To help protect the Nation's critical infrastructure,
DHS created these coordinating councils as the primary means of
coordinating Government and private sector efforts for industry sectors
such as energy, food, and agriculture, telecommunications,
transportation, and water.\12\ Our October 2007 report found that DHS
has used these critical infrastructure coordinating councils primarily
to share pandemic information across sectors and government levels
rather than to address many of the challenges identified by sector
representatives, such as clarifying the roles and responsibilities
between Federal and State governments.\13\ We recommended in the
October 2007 report that DHS encourage the councils to consider and
address the range of coordination challenges in a potential influenza
pandemic between the public and private sectors for critical
infrastructure. DHS concurred with our recommendation and DHS officials
informed us at the time of our February 2009 report that the department
was working on initiatives to address it, such as developing pandemic
contingency plan guidance tailored to each of the critical
infrastructure sectors, and holding a series of ``webinars'' with a
number of the sectors.
---------------------------------------------------------------------------
\12\ The 18 critical infrastructure and key resource sectors are:
Food and agriculture; banking and finance; chemical; commercial
facilities; commercial nuclear reactors, materials, and water; dams;
defense industrial base; drinking water and water treatment systems;
emergency services; energy; governmental facilities; information
technology; national monuments and icons; postal and shipping; public
health and health care; telecommunications; transportation systems; and
critical manufacturing. Critical infrastructure are systems and assets,
whether physical or virtual, so vital to the United States that their
incapacity or destruction would have a debilitating effect on national
security, national economic security, and national public health or
safety, or any combination of those matters. Key resources are publicly
or privately controlled resources essential to minimal operations of
the economy or government, including individual targets whose
destruction would not endanger vital systems but could create a local
disaster or profoundly damage the Nation's morale or confidence.
\13\ GAO-08-36.
---------------------------------------------------------------------------
Federal executive boards (FEB) bring together Federal agency and
community leaders in major metropolitan areas outside of Washington,
DC, to discuss issues of common interest, including an influenza
pandemic. The Office of Personnel Management (OPM), which provides
direction to the FEBs, and the FEBs have designated emergency
preparedness, security, and safety as an FEB core function. The FEB's
emergency support role with its regional focus may make the boards a
valuable asset in pandemic preparedness and response. As a natural
outgrowth of their general civic activities and through activities such
as hosting emergency preparedness training, some of the boards have
established relationships with, for example, Federal, State, and local
governments; emergency management officials; first responders; and
health officials in their communities. In a May 2007 report on the
FEBs' ability to contribute to emergency operations, we found that many
of the selected FEBs included in our review were building capacity for
influenza pandemic response within their member agencies and community
organizations by hosting influenza pandemic training and exercises.\14\
We recommended that, since FEBs are well-positioned within local
communities to bring together Federal agency and community leaders, the
Director of OPM work with FEMA to formally define the FEBs' role in
emergency planning and response. As a result of our recommendation,
FEBs were included in the National Response Framework (NRF) \15\ in
January 2008 as one of the regional support structures that have the
potential to contribute to development of situational awareness during
an emergency. OPM and FEMA also signed a memorandum of understanding in
August 2008 in which FEBs and FEMA agreed to work collaboratively in
carrying out their respective roles in the promotion of the national
emergency response system.
---------------------------------------------------------------------------
\14\ GAO, The Federal Workforce: Additional Steps Needed to Take
Advantage of Federal Executive Boards' Ability to Contribute to
Emergency Operations, GAO-07-515 (Washington, DC: May 4, 2007).
\15\ Issued in January 2008 by DHS and effective in March 2008, the
NRF is a guide to how the Nation conducts all-hazards incident response
and replaces the National Response Plan. It focuses on how the Federal
Government is organized to support communities and states in
catastrophic incidents. The NRF builds upon the National Incident
Management System, which provides a national template for managing
incidents.
---------------------------------------------------------------------------
efforts are underway to improve the surveillance and detection of
pandemic-related threats, but targeting assistance to countries at the
greatest risk has been based on incomplete information
International disease surveillance and detection efforts serve as
an early warning system that could prevent the spread of an influenza
pandemic outbreak. The United States and its international partners are
involved in efforts to improve pandemic surveillance, including
diagnostic capabilities, so that outbreaks can be quickly detected.
Yet, as reported in 2007, international capacity for surveillance has
many weaknesses, particularly in developing countries.\16\ As a result,
assessments of the risks of the emergence of influenza pandemic by U.S.
agencies and international organizations, which were used to target
assistance to countries at risk, were based on insufficiently detailed
or incomplete information, limiting their value for comprehensive
comparisons of risk levels by country.
---------------------------------------------------------------------------
\16\ GAO, Influenza Pandemic: Efforts Under Way to Address
Constraints on Using Antivirals and Vaccines to Forestall a Pandemic,
GAO-08-92 (Washington, DC: Dec. 21, 2007).
---------------------------------------------------------------------------
pandemic planning and exercising has occurred, but planning gaps remain
The National Pandemic Strategy and National Pandemic Implementation
Plan are important first steps in guiding national preparedness.
However, important gaps exist that could hinder the ability of key
stakeholders to effectively execute their responsibilities. In our
August 2007 report on the National Pandemic Strategy and Implementation
Plan, we found that while these documents are an important first step
in guiding national preparedness, they do not fully address all six
characteristics of an effective national strategy, as identified in our
work.\17\ The documents fully address only one of the six
characteristics, by reflecting a clear description and understanding of
problems to be addressed. Further, the National Pandemic Strategy and
Implementation Plan do not address one characteristic at all,
containing no discussion of what it will cost, where resources will be
targeted to achieve the maximum benefits, and how it will balance
benefits, risks, and costs. Moreover, the documents do not provide a
picture of priorities or how adjustments might be made in view of
resource constraints. Although the remaining four characteristics are
partially addressed, important gaps exist that could hinder the ability
of key stakeholders to effectively execute their responsibilities. For
example, State and local jurisdictions that will play crucial roles in
preparing for and responding to a pandemic were not directly involved
in developing the National Pandemic Implementation Plan, even though it
relies on these stakeholders' efforts. Stakeholder involvement during
the planning process is important to ensure that the Federal
Government's and non-Federal entities' responsibilities are clearly
understood and agreed upon. Further, relationships and priorities among
actions were not clearly described, performance measures were not
always linked to results, and insufficient information was provided
about how the documents are integrated with other response-related
plans, such as the NRF. We recommended that the HSC establish a process
for updating the National Pandemic Implementation Plan and that the
updated plan should address these and other gaps. HSC did not comment
on our recommendation and has not indicated if it plans to implement
it.
---------------------------------------------------------------------------
\17\ The six characteristics of an effective national strategy
include: (1) Purpose, scope, and methodology; (2) problem definition
and risk assessment; (3) goals, subordinate objectives, activities, and
performance measures; (4) resources, investments, and risk management;
(5) organizational roles, responsibilities, and coordination; and (6)
integration and implementation. GAO, Combating Terrorism: Evaluation of
Selected Characteristics in National Strategies Related to Terrorism,
GAO-04-408T (Washington, DC: Feb. 3, 2004).
---------------------------------------------------------------------------
Federal Workforce Pandemic Planning
The National Pandemic Implementation Plan required Federal agencies
to develop operational plans for protecting their employees and
maintaining essential operations and services in the event of a
pandemic. In our June 2009 report, we found that Federal agency
progress in pandemic planning is uneven.\18\ We surveyed the pandemic
coordinators from the 24 agencies covered by the Chief Financial
Officers Act of 1990, which we supplemented with a case study approach
of 3 agencies.\19\ We used the survey to get an overview of Government-
wide pandemic influenza preparedness efforts. The survey questions
asked about pandemic plans; essential functions other than first
response that employees cannot perform remotely; protective measures,
such as procuring pharmaceutical interventions; social distancing
strategies;\20\ information technology testing; and communication of
human capital pandemic policies. Although all of the surveyed agencies
reported being engaged in planning for pandemic influenza to some
degree, several agencies reported that they were still in the early
stages of developing their pandemic plans and their measures to protect
their workforce. For example, several agencies responded that they had
yet to identify essential functions during a pandemic that cannot be
performed remotely. And, although many of the agencies' pandemic plans
rely on telework to carry out their functions, 5 agencies reported
testing their information technology capability to little or no extent.
---------------------------------------------------------------------------
\18\ GAO-09-404.
\19\ The survey was conducted from May through July 2008, and the
results were confirmed or updated in early 2009.
\20\ Social distancing is a technique used to minimize close
contact among persons in public places, such as work sites and public
areas.
---------------------------------------------------------------------------
The three case study agencies also showed differences in the degree
to which their individual facilities had operational pandemic plans.
The Bureau of Prisons' correctional workers had only recently been
required to develop pandemic plans for their correctional facilities.
The Department of Treasury's Financial Management Service, which has
production staff involved in disbursing Federal payments such as Social
Security checks, had pandemic plans for its four regional centers and
had stockpiled personal protective equipment. By contrast, the Federal
Aviation Administration's air traffic control management facilities,
where air traffic controllers work, had not yet developed facility
pandemic plans or incorporated pandemic plans into their all-hazards
contingency plans.
State and Local Pandemic Planning
We reported in June 2008 that, according to CDC, all 50 States and
the 3 localities that received Federal pandemic funds have developed
influenza pandemic plans and conducted pandemic exercises in accordance
with Federal funding guidance.\21\ A portion of the $5.62 billion that
Congress appropriated in supplemental funding to HHS for pandemic
preparedness in 2006--$600 million--was specifically provided for State
and local planning and exercising. All 10 localities that we reviewed
in depth had also developed plans and conducted exercises, and had
incorporated lessons learned from pandemic exercises into their
planning.\22\ However, an HHS-led interagency assessment of States'
plans found on average that States had ``many major gaps'' in their
influenza pandemic plans in 16 of 22 priority areas, such as school
closure policies and community containment, which are community-level
interventions designed to reduce the transmission of a pandemic virus.
The remaining 6 priority areas were rated as having ``a few major
gaps.'' Subsequently, HHS led another interagency assessment of State
influenza pandemic plans and reported in January 2009 that although
they had made important progress, most States still had major gaps in
their pandemic plans.\23\
---------------------------------------------------------------------------
\21\ GAO, Influenza Pandemic: Federal Agencies Should Continue to
Assist States to Address Gaps in Pandemic Planning, GAO-08-539,
(Washington, DC: June 19, 2008).
\22\ We conducted site visits to the five most populous States
including California, Florida, Illinois, New York, and Texas for a
number of reasons, including that these States constituted over one-
third of the U.S. population, received over one-third of the total
funding from HHS and DHS that could be used for planning and exercising
efforts, and were likely entry points for individuals coming from
another country given that the States either bordered Mexico or Canada
or contained major ports, or both. Within each State, we also
interviewed officials at 10 localities, which consisted of 5 urban
areas and 5 rural counties.
\23\ DHS and HHS and other agencies, Assessment of States'
Operating Plans to Combat Pandemic Influenza: Report to Homeland
Security Council (Washington, DC: January 2009).
---------------------------------------------------------------------------
As we had reported in June 2008, HHS, in coordination with DHS and
other Federal agencies, had convened a series of regional workshops for
States in five influenza pandemic regions across the country.\24\
Because these workshops could be a useful model for sharing information
and building relationships, we recommended that HHS and DHS, in
coordination with other Federal agencies, convene additional meetings
with States to address the gaps in the States' pandemic plans. As
reported in February 2009, HHS and DHS generally concurred with our
recommendation, but have not yet held these additional meetings.\25\
HHS and DHS indicated at the time of our February 2009 report that
while no additional meetings had been planned, States will have to
continuously update their pandemic plans and submit them for review.
---------------------------------------------------------------------------
\24\ GAO-08-539.
\25\ GAO-09-334.
---------------------------------------------------------------------------
We have also reported on the need for more guidance from the
Federal Government to help States and localities in their planning. In
June 2008, we reported that although the Federal Government has
provided a variety of guidance, officials of the States and localities
we reviewed told us that they would welcome additional guidance from
the Federal Government in a number of areas, such as community
containment, to help them to better plan and exercise for an influenza
pandemic.\26\ Other State and local officials have identified similar
concerns. According to the National Governors Association's (NGA)
September 2008 issue brief on States' pandemic preparedness, States are
concerned about a wide range of school-related issues, including when
to close schools or dismiss students, how to maintain curriculum
continuity during closures, and how to identify the appropriate time at
which classes could resume.\27\ NGA also reported that States generally
have very little awareness of the status of disease outbreaks, either
in real time or in near real time, to allow them to know precisely when
to recommend a school closure or reopening in a particular area. NGA
reported that States wanted more guidance in the following areas: (1)
Workforce policies for the health care, public safety, and private
sectors; (2) schools; (3) situational awareness such as information on
the arrival or departure of a disease in a particular State, county, or
community; (4) public involvement; and (5) public-private sector
engagement.
---------------------------------------------------------------------------
\26\ GAO-08-539.
\27\ National Governors Association Center for Best Practices,
Issue Brief: Pandemic Preparedness in the States--An Assessment of
Progress and Opportunity (September 2008).
---------------------------------------------------------------------------
Private Sector Pandemic Planning
The private sector has also been planning for an influenza
pandemic, but many challenges remain. To better protect critical
infrastructure, Federal agencies and the private sector have worked
together across a number of sectors to plan for a pandemic, including
developing general pandemic preparedness guidance, such as checklists
for continuity of business operations during a pandemic. However,
Federal and private sector representatives have acknowledged that
sustaining preparedness and readiness efforts for an influenza pandemic
is a major challenge, primarily because of the uncertainty associated
with a pandemic, limited financial and human resources, and the need to
balance pandemic preparedness with other, more immediate, priorities,
such as responding to outbreaks of foodborne illnesses in the food
sector and, now, the effects of the financial crisis.
In our March 2007 report on preparedness for an influenza pandemic
in one of these critical infrastructure sectors--financial markets--we
found that despite significant progress in preparing markets to
withstand potential disease pandemics, securities and banking
regulators could take additional steps to improve the readiness of the
securities markets.\28\ The seven organizations that we reviewed--which
included exchanges, clearing organizations, and payment-system
processors--were working on planning and preparation efforts to reduce
the likelihood that a worldwide influenza pandemic would disrupt their
critical operations. However, only one of the seven had completed a
formal plan. To increase the likelihood that the securities markets
will be able to function during a pandemic, we recommended that the
Chairman, Federal Reserve; the Comptroller of the Currency; and the
Chairman, Securities and Exchange Commission (SEC), consider taking
additional actions to ensure that market participants adequately
prepare for a pandemic outbreak. In response to our recommendation, the
Federal Reserve and the Office of the Comptroller of the Currency, in
conjunction with the Federal Financial Institutions Examination Council
and the SEC directed all banking organizations under their supervision
to ensure that the pandemic plans the financial institutions have in
place are adequate to maintain critical operations during a severe
outbreak. SEC issued similar requirements to the major securities
industry market organizations.
---------------------------------------------------------------------------
\28\ GAO, Financial Market Preparedness: Significant Progress Has
Been Made, but Pandemic Planning and Other Challenges Remain, GAO-07-
399 (Washington, DC: Mar. 29, 2007).
---------------------------------------------------------------------------
further actions are needed to address the capacity to respond to and
recover from an influenza pandemic
Improving the Nation's response capability to catastrophic
disasters, such as an influenza pandemic, is essential. Following a
mass casualty event, health care systems would need the ability to
adequately care for a large number of patients or patients with unusual
or highly specialized medical needs. The ability of local or regional
health care systems to deliver services could be compromised, at least
in the short term, because the volume of patients would far exceed the
available hospital beds, medical personnel, pharmaceuticals, equipment,
and supplies. Further, in natural and man-made disasters, assistance
from other States may be used to increase capacity, but in a pandemic,
States would likely be reluctant to provide assistance to each other
due to scarce resources and fears of infection.
Over the last few years, Congress has provided over $13 billion in
supplemental funding for pandemic preparedness. The $5.62 billion that
Congress provided in supplemental funding to HHS in 2006 was for, among
other things: (1) Monitoring disease spread to support rapid response,
(2) developing vaccines and vaccine production capacity, (3)
stockpiling antivirals and other countermeasures, (4) upgrading State
and local capacity, and (5) upgrading laboratories and research at
CDC.\29\ The majority of this supplemental funding--about 77 percent--
was allocated for developing antivirals and vaccines for a pandemic,
and purchasing medical supplies. Also, a portion of the funding that
went to States and localities for preparedness activities--$170
million--was allocated for State antiviral purchases for their State
stockpiles. In June 2009, Congress approved and the President signed a
supplemental appropriations act that included $7.7 billion for pandemic
flu preparedness, including the development and purchase of vaccine,
antivirals, necessary medical supplies, diagnostics, and other
surveillance tools and to assist international efforts and respond to
international needs relating to the 2009-H1N1 influenza outbreak.\30\
This amount included $1.85 billion to be available immediately and $5.8
billion to be available subsequently in the amounts designated by the
President as emergency funding requirements. On July 10, 2009, HHS
announced its plans to use the $350 million designated for upgrading
State and local capacity for additional grants to States and
territories to prepare for the H1N1 pandemic and seasonal influenza.
State public health departments will receive $260 million, and
hospitals will receive $90 million of these grant funds.
---------------------------------------------------------------------------
\29\ Pub. L. No. 109-148 and Pub. L. No. 109-234.
\30\ Pub. L. No. 111-32.
---------------------------------------------------------------------------
An outbreak will require additional capacity in many areas,
including the procurement of additional patient treatment space and the
acquisition and distribution of medical and other critical supplies,
such as antivirals and vaccines for an influenza pandemic.\31\ In a
severe pandemic, the demand would exceed the available hospital bed
capacity, which would be further challenged by the existing shortages
of health care providers and their potential high rates of absenteeism.
In addition, the availability of antivirals and vaccines could be
inadequate to meet demand due to limited production, distribution, and
administration capacity.
---------------------------------------------------------------------------
\31\ Antivirals can prevent or reduce the severity of a viral
infection, such as influenza. Vaccines are used to stimulate the
production of an immune system response to protect the body from
disease.
---------------------------------------------------------------------------
The Federal Government has provided some guidance in addition to
funding to help States plan for additional capacity. For example, the
Federal Government provided guidance for States to use when preparing
for medical surge and on prioritizing target groups for an influenza
pandemic vaccine. Some State officials reported, however, that they had
not begun work on altered standards of care guidelines, that is, for
providing care while allocating scarce equipment, supplies, and
personnel in a way that saves the largest number of lives in mass
casualty event, or had not completed drafting guidelines, because of
the difficulty of addressing the medical, ethical, and legal issues
involved. We recommended that HHS serve as a clearinghouse for sharing
among the States altered standards of care guidelines developed by
individual States or medical experts. HHS did not comment on the
recommendation, and it has not indicated if it plans to implement
it.\32\ Further, in our June 2008 report on State and local planning
and exercising efforts for an influenza pandemic, we found that State
and local officials reported that they wanted Federal influenza
pandemic guidance on facilitating medical surge, which was also one of
the areas that the HHS-led assessment rated as having ``many major
gaps'' nationally among States' influenza pandemic plans.\33\
---------------------------------------------------------------------------
\32\ GAO, Emergency Preparedness: States Are Planning for Medical
Surge, but Could Benefit From Shared Guidance for Allocating Scarce
Medical Resources, GAO-08-668, (Washington, DC: June 13, 2008).
\33\ GAO-08-539.
---------------------------------------------------------------------------
federal agencies have provided considerable guidance and pandemic-
related information, but could augment their efforts
The National Pandemic Implementation Plan emphasizes that
Government and public health officials must communicate clearly and
continuously with the public throughout a pandemic. Accordingly, HHS,
DHS, and other Federal agencies have shared pandemic-related
information in a number of ways, such as through websites, guidance,
and State summits and meetings, and are using established networks,
including coordinating councils for critical infrastructure protection,
to share information about pandemic preparedness, response, and
recovery. Federal agencies have established an influenza pandemic
website (www.pandemicflu.gov) and disseminated pandemic preparedness
checklists for workplaces, individuals and families, schools, health
care, community organizations, and State and local governments.
However, State and local officials from all of the States and
localities we interviewed for our June 2008 report on State and local
pandemic planning and exercising, wanted additional influenza pandemic
guidance from the Federal Government on specific topics, on how to
implement community interventions such as closing schools, fatality
management, and facilitating medical surge. Although the Federal
Government had issued some guidance at the time of our review, it may
not have reached State and local officials or may not have addressed
the particular concerns or circumstances of the State and local
officials we interviewed. More recently, CDC has issued additional
guidance on a number of topics related to responding to the H1N1
outbreak. CDC issued interim guidance on school closures which
originally recommended that schools with confirmed H1N1 influenza
close. Once it became more clear that the disease severity of H1N1 was
similar to that of seasonal influenza and that the virus had already
spread within communities, CDC determined that school closure would be
less effective as a measure of control and issued updated guidance
recommending that schools not close for suspected or confirmed cases of
influenza.\34\ However, the change in guidance caused confusion,
underscoring the importance of clear and continuous communication with
the public throughout a pandemic. In addition, private sector officials
have told us that they would like clarification about the respective
roles and responsibilities of the Federal and State governments during
an influenza pandemic emergency, such as in State border closures and
influenza pandemic vaccine distribution.
---------------------------------------------------------------------------
\34\ Centers for Disease Control and Prevention, Update on School
(K-12) and Child Care Programs: Interim CDC Guidance in Response to
Human Infections with the Novel Influenza A (H1N1) Virus (Updated May
22, 2009).
---------------------------------------------------------------------------
performance monitoring and accountability for pandemic preparedness
needs strengthening
While the National Pandemic Strategy and Implementation Plan
identify overarching goals and objectives for pandemic planning, the
documents are not altogether clear on the roles, responsibilities, and
requirements to carry out the plan. Some of the action items in the
National Pandemic Implementation Plan, particularly those that are to
be completed by State, local, and Tribal governments or the private
sector, do not identify an entity responsible for carrying out the
action. Most of the implementation plan's performance measures consist
of actions to be completed, such as disseminating guidance, but the
measures are not always clearly linked with intended results.
For example, one action item asked that all HHS-, Department of
Defense-, and Veterans Administration-funded hospitals and health
facilities develop, test, and be prepared to implement infection
control campaigns for pandemic influenza within 3 months. However, the
associated performance measure is not clearly linked to the intended
result. This performance measure states that infection control guidance
should be developed and disseminated on www.pandemicflu.gov and other
channels.\35\ This action would not directly result in developing,
testing, and preparing to implement infection control campaigns. This
lack of clear linkage makes it difficult to ascertain whether progress
has in fact been made toward achieving the national goals and
objectives described in the National Pandemic Strategy and
Implementation Plan. Without a clear linkage to anticipated results,
these measures of activities do not give an indication of whether the
purpose of the activity is achieved. In addition, as discussed earlier,
the National Pandemic Implementation Plan does not establish priorities
among its 324 action items, which becomes especially important as
agencies and other parties strive to effectively manage scarce
resources and ensure that the most important steps are accomplished.
Moreover, the National Pandemic Strategy and its Implementation Plan do
not provide information on the financial resources needed to implement
them, which is one of six characteristics of an effective national
strategy that we have identified. As a result, the documents do not
provide a picture of priorities or how adjustments might be made in
view of resource constraints.
---------------------------------------------------------------------------
\35\ Homeland Security Council, National Strategy for Pandemic
Influenza Implementation Plan (Washington, DC: May 2006).
---------------------------------------------------------------------------
As discussed earlier, the National Pandemic Implementation Plan
also required Federal agencies to develop operational pandemic plans to
describe, among other requirements, how each agency will protect its
workforce and maintain essential operations and services in the event
of a pandemic.\36\ We recently reported, however, that there is no
mechanism in place to monitor and report on agencies' progress in
developing these plans. Under the Implementation Plan, DHS was charged
with this responsibility, but instead the HSC simply requested that
agencies certify to the council that they were addressing in their
plans the applicable elements of a pandemic checklist. The
certification process did not provide for monitoring and reporting on
agencies' abilities to continue operations in the event of a pandemic
while protecting their employees. Moreover, even as envisioned under
the Implementation Plan, the report was to be directed to the Executive
Office of the President with no provision for the report to be made
available to Congress.
---------------------------------------------------------------------------
\36\ GAO-09-404.
---------------------------------------------------------------------------
As noted earlier, given agencies' uneven progress in developing
their pandemic plans, monitoring, and reporting would enhance agencies'
accountability to protect their employees during a pandemic. We
therefore recommended that the HSC request that the Secretary of
Homeland Security monitor and report to the Executive Office of the
President on the readiness of agencies to continue their operations
while protecting their employees in the event of a pandemic. We also
suggested that to help support its oversight responsibilities, Congress
may want to consider requiring DHS to report to it on agencies'
progress in developing and implementing their plans, including any key
challenges and gaps in the plans. The HSC noted that it will give
serious consideration to the report findings and recommendations, and
DHS said the report findings and recommendations will contribute to its
efforts to ensure that Government entities are well-prepared for what
may come next.
concluding observations
The current H1N1 influenza pandemic should serve as a powerful
reminder that the threat of a more virulent pandemic, which seemed to
fade from public awareness in recent years, never really disappeared.
While Federal agencies have taken action on many of our
recommendations, about half the recommendations that we have made over
the past 3 years are still not fully implemented. It is essential,
given the change in administration and the associated transition of
senior Federal officials, that the shared leadership roles that have
been established between HHS and DHS, along with other responsible
Federal officials, are tested in rigorous tests and exercises.
Likewise, DHS should continue to work with other Federal agencies and
private sector members of the critical infrastructure coordinating
councils to help address the challenges of coordination and clarify
roles and responsibilities of Federal and State governments. DHS and
HHS should also, in coordination with other Federal agencies, continue
to work with States and local governments to help them address
identified gaps in their pandemic planning. Moreover, the 3-year period
covered by the National Pandemic Implementation Plan is now over and it
will be important for HSC to establish a process for updating the
National Pandemic Implementation Plan so that the updated plan can
address the gaps we have identified, as well as lessons learned from
the current H1N1 outbreak. Finally, greater monitoring and reporting of
agencies' progress in plans to protect their workers during a pandemic
are needed to insure the readiness of agencies to continue operations
while protecting their employees in the event of a pandemic.
Pandemic influenzas, as I noted earlier, differ from other types of
disasters in that they are not necessarily discrete events. While the
current H1N1 pandemic seems to be relatively mild, the virus could
become more virulent this fall or winter. Given this risk, the
administration and Federal agencies should use this opportunity to turn
their attention to filling in some of the planning and preparedness
gaps our work has pointed out, while time is still on our side.
Chairman Thompson and Members of the committee, this concludes my
prepared statement. I would be happy to respond to any questions you
may have.
Chairman Thompson. Thank you very much for your testimony.
I now recognize myself for 5 minutes of questioning.
Mr. Corr, if we had an outbreak of H1N1 tomorrow, do we
have enough vaccine on hand now to address it or are we still
short?
Mr. Corr. Mr. Chairman, we are taking all of the necessary
steps to develop the vaccine, but it will not be available for
use for several more months. Clinical trials at the National
Institutes of Health and among the vaccine manufacturers are
now underway. We need the results of those trials to understand
the level of dosing and the immune response, whether we are
getting sufficient immune response. We also need further
information about the virus itself which we are collecting in
the southern hemisphere as well as in the States.
So we expect that we will be in a position to do a
vaccination campaign if the decision is made to proceed with
one in the September/October time frame.
Chairman Thompson. Thank you.
Dr. Lute, given the fact that we don't at this point have
enough of the vaccine on hand, what plans has DHS put into
place in the interim to address any potential outbreak?
Ms. Lute. Mr. Chairman, as I mentioned in my opening
remarks, there is a Federal plan for 2009 H1N1 that is in final
stages of completion, as well as a Departmental plan within
DHS. As was noted, all of the Federal agencies are themselves
responsible for developing plans to continue to execute their
mission responsibilities in the event of an outbreak.
Equally, State and local authorities, municipalities, have
been engaged in planning and we have been providing them
through FEMA planning templates and planning training and
assistance to prepare for the coming fall.
Chairman Thompson. Thank you.
Now Ms. Steinhardt, in your review, you indicated that some
of these National plans probably needed updating or, in some
instances, were outdated. Did you make some suggestions to
either DHS or HHS that they do this? If so, do you have any
knowledge as to whether or not they have updated those plans?
Ms. Steinhardt. Thank you, Mr. Chairman for your question.
To our knowledge, they have not updated the plans. I am
interested in Secretary Lute's comments about a Federal
implementation plan that is in draft stage. We haven't seen
that yet and so can't comment on it.
But I would say in the past when we have looked at the
current version of the implementation plan and National
strategy, we noted a number of gaps in what is included there.
But I would say that the most significant one was the fact
that many of the action items in the plan were assigned to
State and local governments, but there had been no consultation
with State and local governments in the drafting of that plan.
When we talked to some of them, some of the State and local
governments, particularly at the local level, they weren't even
aware that they had responsibility for any of the action items.
Chairman Thompson. Dr. Lute, could you provide the
committee with a copy of this draft plan you talked about?
Ms. Lute. Mr. Chairman, we will certainly share with this
committee all of the preparations that we are undertaking. Let
me just use this opportunity, if I might, to reflect on Ranking
Member King's questions on lessons learned from the spring.
What we learned over the past several months is that
several principles are operating here:
No. 1, rest on the science.
No. 2, planning is key.
No. 3, consistent communication across the Federal
Government and between the Federal Government and State and
local municipal authorities across public health sectors,
public policy sectors, governmental sectors as well is also
key. While we are not satisfied with progress to date, we can
say with great conviction that a good deal of progress has
occurred and we now have an elaborated matrix of action
requirements across the Federal Government and between us and
the State and locals to ensure that we are prepared for the
fall.
Chairman Thompson. Thank you.
Mr. Corr, I am not certain, are you aware of some
information that we have that some pages might have come down
with H1N1-like symptoms?
Mr. Corr. I read that in the paper this morning, yes.
Chairman Thompson. But you don't have any knowledge beyond
what you read in the paper?
Mr. Corr. I do not.
Chairman Thompson. Dr. Lute.
Ms. Lute. Equally.
Chairman Thompson. Well, part of our dilemma as Members of
Congress is we have been involved and potentially in contact
with some of the people, and we have no knowledge of it other
than reading it in the paper. I think part of the issue that
Ms. Steinhardt's report goes to is we don't have a plan of
informing people when potential situations like this exist.
Ms. Steinhardt, do you have any comments on what you think
people in a situation like this at a minimum should be informed
of?
Ms. Steinhardt. Well, I can't speak, Mr. Chairman, to the
specifics of this situation. But I do think it underscores the
importance of having operational plans, plans at a sufficient
level of detail so that when these kinds of situations arise,
organizations, people within the organization know exactly what
they need to do to follow up on that situation. It is not
enough to just have something that is very high level.
Chairman Thompson. Again, this was brought to my attention
in the newspaper, too. I thought it was kind of interesting
that Members of Congress didn't have any way of being told of
the situation or the Senate or what have you. The gentleman
from New York for 5 minutes.
Mr. King. Thank you, Mr. Chairman.
Secretary Corr, you said right now you are evaluating the
virus. Is it too early to say how virulent it might be, to make
estimates if it is going to be more severe than last spring?
Mr. Corr. Congressman, the experts at CDC are continuing to
watch what happens in this country with regard to the spread
and the virulence of the virus. We are watching very closely in
the southern hemisphere, and so far it appears to have a
similar pattern. In some places the disease has had a serious
effect on individuals. In other places it has been mild, as it
has been in the United States. The virus itself does not appear
to be mutating which is important information.
But again, we are collecting information. We are just
reaching the height of the southern hemisphere's flu season. So
the short answer is that there is a great deal of information
that we will continue to collect that will inform the decision
about whether to do a vaccination campaign here in the United
States.
In the mean time, there is a great deal that every
individual can do. One of the most important messages that I
think we need to get out to the American people is that every
individual, every family, every business, every school, has a
responsibility to understand what they can do to mitigate the
spread of the disease. It certainly is an issue for Members. As
many people as you shake hands with and see every day, there is
some very basic information that we need in everyone's
knowledge base, which is wash your hands frequently, cover your
nose and mouth with your arm and not with your hand when you
sneeze or cough. If you have a fever or flu-like symptoms, stay
home.
We need to get this message out. We are working daily with
State and local health departments. We are developing
communication plans that will continue to spread this word.
There is a great deal of public information.
Mr. King. Secretary Corr, along those lines, if and when a
vaccine is being used, are you going to have rapid response
teams ready to answer the questions that the public will have
because I am sure we can expect rumors, some true, some false,
conspiracy theories, and everything else. Are you going to be
able to go after them right away and have answers for the
public?
Mr. Corr. As best we can. We understand that it is critical
for the public to trust the vaccines and the public health
experts who are recommending them. We will do everything that
we can to make sure that we have accurate information available
for everyone.
Mr. King. As far as lessons learned, as far as your two
departments are concerned, do you feel that the level of
coordination was sufficient? Can that be improved on? After,
Ms. Steinhardt, I would ask if you would comment on what you
think of the level of coordination during the last crisis, if
you will?
Ms. Lute. Thank you. From our point of view, the spring was
an excellent example of very tight and close coordination from
the leading public health agency in the Federal Government and
the leading National incident management agency. From the very
outset of the outbreak of H1N1 in the spring, we closely
liaised with HHS to establish what the science was. Our aim
jointly that we pursued at every level from the Secretaries on
down to the working level was designed to create empowered
individuals, capable communities, and a responsive Federal
system to identify where the gaps were in our knowledge, to
understand what were the responsible messages to be sending
out, and to engage State and local tribal authorities at times
on multiple times a day during the spring. So from our point of
view, this coordination was important. It was emblematic. We
have built on it over the intervening weeks to prepare
ourselves for the fall.
Mr. Corr. I certainly agree with that. Given the speed with
which the virus came upon us, we felt like at HHS, that there
was outstanding leadership from DHS in coordinating all of our
activities and integrating our science and public health
experts into the decision-making process. Our two Secretaries
were leaders in terms of talking to the American people about
what to expect. We felt like it was an excellent working
relationship. We need to always build on it and we need to
incorporate, as GAO has pointed out, our State and local and
territorial and tribal partners. We need to incorporate the
business communities in all of our plans going forward, and are
attempting to do that.
I urge you to take a look at the CDC website at Flu.gov.
There are extensive guidelines that are for different provider
groups, businesses, individuals. We are trying to provide as
much information as rapidly as we can. It is evolving as we
learn more. But we are trying to provide guidance to the
Department of Education. Our Departments are working very
closely with the Department of Education so we give good
guidance for schools for the fall.
Ms. Steinhardt. I would say certainly looking at it from
the outside, the coordination seemed to work very well at the
beginning of the H1N1 outbreak. But I would point out that at
the time, Secretary Sebelius hadn't been confirmed yet in her
position so we just had at the beginning Secretary Napolitano
leading the effort, as it were, along with obviously others in
the two departments.
The pandemic itself, it hadn't reached pandemic proportions
yet. It was not yet a severe outbreak, and so it didn't call on
all of the resources that might be called on in a more severe
pandemic situation. We still haven't tested that kind of
scenario, and that still remains to be done.
Mr. King. Thank you very much. Thank you, Mr. Chairman.
Chairman Thompson. Thank you very much.
Mr. Corr, for the sake of the information, once the vaccine
is available, do you plan to make it available to the public
free of charge?
Mr. Corr. The short answer is, yes; but let me just back
up, Mr. Chairman, to say one of the big differences in this
effort with this virus is that the decision to make a vaccine
and the decision to use it have been separated. We are doing
everything in our power to get a vaccine ready; and in the
coming months, we will make the decision whether we should have
a vaccination campaign. We expect there will be one, but that
decision hasn't been made. It would be distributed free of
charge. We hope in the distribution system, if there is
insurance coverage--Mr. Chairman, let me back up and correct
myself just a little bit.
There are still some key decisions like the feasibility of
having private insurance that already covers vaccines to cover
it. We are moving very quickly on trying to develop a
distribution system since we will need a mixed distribution
system, some through the private system and some publicly if we
have to vaccinate a large number of Americans. So the
feasibility of some aspects of the distribution system still
have to be determined.
Chairman Thompson. Thank you very much.
The gentleman from Texas, Mr. Green, for 5 minutes.
Mr. Green. Thank you, Mr. Chairman. I thank the witnesses.
I especially thank the staff members for the excellent material
that has been accorded us. I have found it to be fascinating. I
am moved by an indication and perhaps I should ask a question
rather than make a statement.
Is it true that the United States of America has more cases
recorded than any other country? Is this true?
According to what I am looking at, we have 40,556, and that
makes us about 40 percent of all of the known cases on record.
Mr. Corr. Congressman Green, between the United States and
Mexico, you have the vast majority of confirmed cases. But let
me point out that the CDC estimates that there may have been a
million Americans exposed to H1N1. So the number of confirmed
cases is a fraction of what we actually expect has happened.
Mr. Green. With 40,000, that gives us about 40 percent of
the known cases, and it appears, and I would be tempted to ask
a question, is it true that we have the most deaths reported?
My intelligence indicates that we have 263 which appears to be
half of all of the known deaths; is this true?
Mr. Corr. The latest CDC numbers are 302 deaths in the
United States as of July 24. Let me just ask. This is Dr.
Nicole Lurie, who is the Assistant Secretary for Preparedness
and Response and has some of the individual numbers. We will
get that for you.
Mr. Green. Listen, let me just say this to you, I have been
where you are, and I have had to look back too, and I
appreciate that.
Mr. Corr. Thank you. I want to get you accurate
information.
Mr. Green. I am asking because while we have more
population, we don't have more than China or India. We don't
have more than a lot of other places in the world, and when we
are 40 percent of all of the known cases in the world and half
of all of the known deaths in the world, that causes me to
pause and ask what is happening here in the United States?
Mr. Corr. Congressman Green, we also have the finest
surveillance system in the world, and I think we have a great
deal more knowledge about what is happening among our citizens.
Let me point out to you that in a normal flu season, 36,000
Americans die from seasonal flu, including 500 to 1,000
children. So the regular seasonal flu takes a huge impact on
our population. That is why we are so concerned about H1N1,
because it is a novel virus and could potentially do greater
harm.
Mr. Green. I would assume that we are concerned because of
the possibility of simultaneous infections that will lead to
mutations?
Mr. Corr. That is the reason we are doing enhanced
surveillance in the southern hemisphere. What can happen with a
virus, as it moves to the southern hemisphere during their flu
season is it can mutate and come back to the United States in a
more virulent form. We are tracking it as carefully as we can
to understand whether that is happening. So far it doesn't
appear that it is, but we won't have final conclusion until we
get further into the southern hemisphere's flu season.
Mr. Green. Just one final question. The magnitude of this,
we don't want to overexaggerate. We want to make sure that we
maintain a level of understanding such that the public won't
panic. It is important not to panic. But by the same token, it
is important to understand the magnitude of what we may be
confronting. I have a little bit of concern when I read the
report that I have about the possibility of mutation and the
impact of a mutated virus and also when I look at how we have
handled this thus far. Just do this for me, when do you think
we will know, have some idea as to whether the current vaccines
that we have will be efficacious as opposed to having to deal
with a mutation that may create another dynamic that we need
not discuss?
Mr. Corr. I will correct this for the record if I need to,
but I think the clinical trials will occur over the next 2
months. But I think in the next month, we will have additional
information about the type of vaccine that we would use. Within
the next 2 months, we will have a great deal more information
about the actual virus itself and whether it has mutated as it
had moved from the southern hemisphere back to the United
States.
Mr. Green. Thank you. I yield back the balance of my time.
Chairman Thompson. I recognize Mr. McCaul from Texas for 5
minutes.
Mr. McCaul. Thank you, Mr. Chairman.
So the strain we see today when seasonal flu season hits,
it more likely than not will be a different type of influenza;
is that correct?
Mr. Corr. That is correct.
Mr. McCaul. So the challenge will be to predict what the
mutations will be, like you do with the influenza vaccines
every year; is that correct?
Mr. Corr. That is precisely the case.
Mr. McCaul. I am concerned about this going into even a
more deadly strain and what DHS and HHS has planned to deal
with that. One is obviously the vaccine, trying to predict
that, and the other issue would be the antivirals. Would the
antivirals we have today be effective on a mutated strain?
Mr. Corr. Well, we know that the antivirals we have today
are effective against H1N1. I am not probably in the best
position to answer the question about if there are mutations,
but we can certainly get that information for you.
Mr. McCaul. Just hypothetically, if it mutates into a
strain that the vaccine cannot deal with or cover, we obviously
would be looking at another vaccine and then the reliance on
these antivirals would increase; is that fair?
Mr. Corr. Yes. We would have to rely also upon community
mitigation practices. It would involve encouraging people not
to form in large groups. It may involve closing schools. The
guidance as to when to consider closing schools is being
written and will be available. Individual practices are so
important under those circumstances. Businesses will have to
plan. All of these things need to happen if we go forward with
H1N1; and certainly if there is a variation on H1N1 as it comes
back, it would be even more important for those practices to be
followed.
Mr. McCaul. Where are we right now with the stockpiling of
these antivirals? I know that the National strategy relies on
the States to purchase these, and maybe 31 million courses of
treatment. The States have not purchased that amount yet; have
they?
Mr. Corr. My understanding is that we have roughly 35
million courses of treatment which is a full course among the
States now. An additional--the total is somewhere between 75
and 100 million total courses available through the Federal
Government and the State governments.
Mr. McCaul. Do you feel that we have an adequate supply
stockpiled to deal with this if the vaccine is not successful?
Mr. Corr. Our public health experts believe that for the
virus as we now project it, that we have sufficient antivirals.
We have the manufacturers working full speed on antivirals, and
we have purchased the capacity to develop the vaccine so we
have moved ahead to make contracts to be sure that we have the
manufacturing capacity committed to us to make the necessary
medicines and vaccines.
Mr. McCaul. When you look at mutations, and I am not an
expert in this area but you are, but as we look at mutations,
is it typical to look at, say, Latin America as they are
dealing with their different change of seasons from ours and
then it moves up north?
Mr. Corr. It is across the entire southern hemisphere, in
South America. We are looking in South Africa and Australia.
Basically it is the flu season in the southern part of the
world where we are looking because the virus moves to the
colder climate, and then as it turns colder here, it is back in
the United States.
Mr. McCaul. So it is safe to say that when we hit the fall,
we will have an increase in cases of H1N1?
Mr. Corr. We expect we will; and we expect we will also
have seasonal flu circulating at the same time.
Mr. McCaul. What we have seen happen in terms of the colder
climates, this influence of virus has not mutated in any
significant way?
Mr. Corr. So far.
Mr. McCaul. That is the good news.
Mr. Corr. It certainly is.
Chairman Thompson. The gentleman from Pennsylvania for 5
minutes.
Mr. Carney. Thank you, Mr. Chairman.
My question goes back to the planning aspect also. How are
you employing the universities for the regional bio labs that
exist, or are you for this?
Mr. Corr. There is a network of universities that work with
the NIH in our clinical studies, and the NIH has extensive
experience in vaccine research and they are employing all of
the resources that we have across the country to conduct the
necessary trials and to collect as much information as we can
as we go forward to make the decision about a vaccination
program.
Mr. Carney. Are those research labs, biocontainment labs
part of a surge capacity? Ms. Lute.
Ms. Lute. We are relying on the National labs for modeling
information, and I think it is fair to say that we are jointly
with HHS and with the other parts of the Federal family working
very hard to mobilize the very best resources this country has
to offer in order to fully anticipate how this virus will
reoccur in the United States and be attentive and responsive if
it does mutate. We are anticipating a number of scenarios.
Again, we are in constant touch across the Federal agencies
with State and local authorities with these sources of
expertise to be sure that the very best knowledge is deployed
to keep Americans safe.
Mr. Carney. Respectfully, we spent $250 million on these
regional biocontainment labs, and the upkeep hasn't been there.
Are they going to be ready to go if we need them? Is there a
way to make sure that we can continue to fund them because the
upkeep hasn't been there? Are you planning on doing an
investigation into their levels of readiness should they have
to surge? Are you talking about perhaps a competitive grant
program for them to ensure that they can meet the standards
that we expect, that were intended?
Ms. Lute. A process of readiness and preparedness for the
fall, it ranges across all of the capabilities that will be
required. We know that facilities are important, a important
component of that.
Mr. Carney. That is not the question.
Ms. Lute. We are doing everything that we can to ensure
that we will be ready for the fall.
Mr. Carney. Okay. Thank you, Mr. Chairman.
Chairman Thompson. Thank you very much.
The gentleman from Louisiana, Mr. Cao for 5 minutes.
Mr. Cao. Thank you, Mr. Chairman.
This is a question to the panel. Besides incapacitating the
work force, what other Homeland Security issues do you
anticipate from the H1N1 virus?
Ms. Lute. Among the issues that we are looking at is how
State and local authorities, municipal authorities, are able to
respond to the challenges that they face across public health,
emergency response. Are there medical centers that they have
and the critical infrastructure that sustains those medical
centers? Have they done adequate planning? Are they doing
adequate cross communication and talk? Are we aware of what
weaknesses and gaps may exist? Are we taking appropriate action
to fill them?
Secretary Corr mentioned the importance of schools. Schools
are a particular source of incubation and transmission for
H1N1. We know that. We are working very closely with the
Department of Education and CDC to ensure that responsible
guidance is formulated and disseminated in a timely way.
So in every dimension of public health, Secretary Corr can
speak to, but emergency management and public policy response,
we are paying attention.
Mr. Cao. Is there a possibility that the H1N1 virus can be
turned into a weapon?
Ms. Lute. There are scenarios under which biological agents
naturally occurring or occurring through man-made processes can
be weaponized; but we have no indication in the current
circumstance that anything regarding the H1N1 outbreak in the
United States, or as it has unfolded in the hemisphere is, in
any way, associated with that.
Mr. Cao. Are the amounts of funding that you have received,
are they sufficient to help your agencies coordinate with the
State and local governments in connection with the H1N1 virus?
Mr. Corr. Congressman, the supplemental funds that we have
received, as I mentioned in my opening statement, a portion of
those, $350 million have been granted to State and local
government as well as to hospitals for preparedness planning.
So that is the initial sources of funding that are going out.
CDC is providing extensive guidance to State and local and
territorial health departments, as well as Tribal governments,
and we are working closely with them.
Mr. Cao. A district like mine, 80 percent of the city post-
Katrina lacks a health care system and possibly medical
providers to address a pandemic. How would Homeland Security
and the different agencies address areas that are in tremendous
need like New Orleans?
Mr. Corr. May I just say initially in terms of the
distribution of a vaccine if we were to conduct a vaccination
campaign, one of the reasons for a mixed distribution system is
to provide public health department sites so that individuals
who don't have a regular provider, or if there is an inadequate
number of medical providers, there is a place where all
individuals would be able to go to get vaccinated.
Mr. Cao. Thank you very much.
Chairman Thompson. Thank you very much.
The gentleman from New Mexico, Mr. Lujan, for 5 minutes.
Mr. Lujan. Thank you, Mr. Chairman.
Mr. Chairman, before I begin with my questions, in regards
to the committee markup of H.R. 1881, the Transportation
Security Workforce Enhancement Act of 2009, I ask unanimous
consent that the record for the markup reflect that I would
have voted ``yea'' on the question of adoption had I been
present.
Chairman Thompson. Hearing no objection, so ordered.
Mr. Lujan. Mr. Chairman, thank you very much for this very
important hearing.
Mr. Corr, did I hear correctly that as we are preparing for
this, that one of the things that has been looked at on how we
will deliver some of the antiviral medication necessary to be
distributed to people will be if their health insurance allows
for it to be paid for?
Mr. Corr. The question involved the vaccine distribution
system. If we were to do a vaccination campaign that covers
hundreds of millions of Americans, which is one possibility,
the question is how we do that in a timely fashion? The
expectation is that we would want to distribute it to
providers, but also through public sites so that we can be sure
that the priority groups that need the vaccine first receive
it; and, secondly, so we actually reach the Americans that we
need to.
One of the issues we will have to deal with is we have the
funds to pay for that vaccine, but to the extent that private
insurance covers it, the decision would have to be made about
whether to have the insurance companies cover that particular
shot. The first and most important aspect of this is to get
people vaccinated. If people go without vaccination, they may
be exposed to H1N1 and become sick and expose others. So it is
first and most important that we have a vaccination campaign,
and those decisions will be made in that context.
Mr. Lujan. So in that situation, Mr. Corr, it sounds like
the more people we have covered, the better off we will be?
Mr. Corr. I think that is always the case when it comes to
health care.
Mr. Lujan. Interesting.
My next question is for Dr. Lute. In regards to H1N1,
earlier in the year there was attention brought to the fact
that Los Alamos National Laboratory and Sandia National
Laboratory have in place a National Infrastructure Simulation
and Analysis Center. I know some work was done in order to
collaborate with them from a modeling perspective and
preparation for what we could anticipate with this pandemic.
What is the Department doing to work with our laboratories in
utilizing NISAC and other resources to allow us to get out in
front of this and continue to see what we can do from a
preparedness perspective?
Ms. Lute. Preparedness, as I mentioned, is a key concern of
ours. To the extent planning and good modeling can inform
planning, not only for how the virus will unfold and
potentially spread in a community, there is a certain degree of
unpredictability to this. This virus has a degree of virulence
which is uneven, as we have come to understand it. So working
very closely with the labs on the modeling and the entire
environment of biosurveillance is key. As I mentioned earlier,
we will rest on the science in making policy recommendations to
State and locals.
Mr. Lujan. In regards to preparation, getting the word out,
coming from a border State, I hope that we are preparing in
multiple languages, including Spanish. The district I represent
represents many native nations, and so I hope that is being
considered as we prepare in that regard.
Speaking to that specifically with our tribal nations, what
is being done to specifically coordinate with them and how can
that be improved?
Ms. Lute. From the perspective of the Department of
Homeland Security, we have engaged in extensive coordination.
We have had weekly conference calls continuing from the spring
experience that we have had. We send out e-mail updates. The
flu summit, as I mentioned earlier, involved State and local
authorities, and urging them to put the word out. There will be
webcasts in August. FEMA is engaging at a regional level to
provide additional information and guidance for State and local
plans. In addition, we are putting out teams specifically
focused on pandemic preparedness to ensure that we are aware of
gaps or problems that exist at the earliest opportunity.
Mr. Lujan. Mr. Chairman, I would just close bringing our
attention to one of the points that staff put in our report,
which is that we need to drive to make every effort to do what
we can now to save as many lives as possible in the future, and
I think that should include now and in the future, Mr.
Chairman. I think that it is important that we keep our eye on
that ball.
Chairman Thompson. I agree with you. The gentleman from New
Jersey for 5 minutes.
Mr. Pascrell. Mr. Chairman, may I simply start by saying
that I think our committee should ask, and I am asking and if
you think it is not in order----
Chairman Thompson. Excuse me, Mr. Pascrell. Mr. Olson is
next for 5 minutes. I hope the gentleman from New Jersey
forgives me for that.
Mr. Olson. Thank you all for coming today. I have a
question for both Secretary Lute and Secretary Corr. About this
time last year in September, my region was hit by Hurricane Ike
which devastated much of the region and had a particular impact
on some of the health care aspects, particularly the University
of Texas, Galveston's medical branch. It basically was lost.
They opened up their level 3 trauma center just this past week.
They had been a level 1 before. We are under siege again.
August and September are historically the big months when the
strong hurricanes come through.
If we had the misfortune of having a category 3, 4, or 5
hurricane come hit the Texas Gulf Coast while we are in the
middle of some sort of pandemic, H1N1, have you done the
planning and do you have the resources to make sure that you
can respond to both of those so that the pandemic doesn't run
out of control?
Mr. Corr. Congressman, you raise a very, very important
question which we have asked ourselves. What the Department has
done is go through our hurricane preparedness planning in every
aspect and ask ourselves the question if we are in the middle
of an H1N1 outbreak, how does it change what we need to do? How
do we move patients? Where do we put individuals?
The one thing you don't want to do in an H1N1 outbreak is
collect lots of people in a small room, but that may be all we
can do to move people out of the way of a hurricane. All
aspects are being gone through thoroughly. We meet regularly
with our State preparedness and emergency manager coordinators.
So we will be working closely with them. We will be discussing
this very situation, and we will provide extensive guidance
before we get to flu season here again so we are in a
comfortable position that we know how to act in the case we
have an outbreak at the same time.
Mr. Olson. Secretary Lute.
Ms. Lute. What I would say is that the health and safety of
citizens in a circumstance where we would have multiple issues
to deal with of a significant traumatic nature for a community
are very much on both of our minds. This is part of the
contingency planning that we are doing. FEMA, at the outset of
the hurricane season, convened a meeting of governors of States
where hurricanes routinely hit during the hurricane season to
advise them of preparedness measures, changes from procedures
and issues to make them more aware of the hurricane dimension
of that. In the context of that meeting, which I attended, and
the Secretary did as well, the H1N1 virus and its reappearance
was raised as well. As I mentioned, we have been in weekly
contact, sometimes daily contact on these issues, to ensure
preparedness, and we are thinking about the contingencies that
you have raised.
Mr. Olson. Thank you very much for that answer.
One question about the liability, and that is for you,
Secretary Corr: Can HHS ensure us that the liability issues are
being addressed concerning the administration of a new vaccine
so the health care workers are provided the coverage and will
participate in the vaccination programs and won't be worried
about the liability?
Mr. Corr. My understanding is that current law protects
them.
Mr. Olson. Thank you very much, Mr. Chairman. I yield back
the balance of my time.
Chairman Thompson. Now the gentleman from New Jersey, Mr.
Pascrell. We have about 4 minutes left on the vote.
Mr. Pascrell. No problem, Mr. Chairman.
Mr. Chairman, I am going to be asking for unanimous consent
from both sides. We have heard some very startling testimony
today from GAO. Every time you come here it is startling.
I think that we should ask both Departments, who I have a
great deal of respect for, that they respond to all of the
concerns and recommendations laid before us today within the
next 3 months. I ask unanimous consent for that request, Mr.
Chairman?
Chairman Thompson. Without objection.
Mr. Pascrell. Thank you.
Mr. Chairman, there are some concerns about whether
Stafford Act disaster assistance is applicable here. Will the
Department retain the FEMA disaster assistance policy on
influenza pandemic which was issued in 2007?
Ms. Lute. Congressman, what I can say is that the Stafford
Act may be invoked under certain contingencies, and as may
arise in the fall with the pandemic, and we plan for those
contingencies and are prepared to respond appropriately.
Mr. Pascrell. I just wanted to get you on the record for
that. I think that is very critical to what we are talking
about today.
My next question is to both you, Dr. Lute, and Mr. Corr.
Can you tell me, the replenishing of the 11 million antivirals
in the Strategic National Stockpile, was that a one-time act or
do you view it as the standard operating procedure as the
Federal Government moves forward in facing the threat of H1N1
in the coming months?
Chairman Thompson. We have 2 minutes left in the vote.
Ms. Lute. Certainly from the perspective of the Department
of Homeland Security, maintaining a current and effective
stockpile is essential. That is an on-going process.
Mr. Pascrell. So this is going to be a regular practice?
Mr. Corr. Certainly the purpose of the stockpile is to have
it ready and available in the event it is needed.
Mr. Pascrell. That may be the purpose. But I want to hear
from you that this is going to be regular procedure and that
this is not simply a one-shot deal. That is my concern.
Mr. Corr. The Department of Health and Human Services
certainly values the Strategic National Stockpile and hopes
that it will stay full.
Mr. Pascrell. My final question is what do you tell mothers
and fathers about what they should be telling their kids about
this particular virus we are talking about today?
Mr. Corr. They should make getting the vaccination, if it
happens, something that children view as, and I have got
children and I am not sure how you make it fun to do, but you
have to impress upon them the importance of it. Because I think
they are going to hear about it in school. They are going to
hear about the things they need to do depending upon their age,
so I think we need to have a broad public discussion about this
if we are going to succeed in our efforts.
Chairman Thompson. Thank you very much. The committee will
recess to take three votes. It should be about 20 minutes.
[Recess.]
Chairman Thompson. We would like to reconvene our recessed
meeting. We have been told that we have about an hour before
the next series of votes.
At this point, our gentlelady from New York, if she has any
questions, while she is getting ready, a comment came to mind
for the panel relative to the vaccine that we talked about a
little earlier and the question continues to be, when we have
reached the critical number that the Department is comfortable
with, will the Department look at some distribution process
that would allow the immunization to occur; or is your
testimony, Mr. Corr, that that is still being looked at?
Mr. Corr. Mr. Chairman, one of the important lessons
learned in 1976 with the previous swine flu vaccination program
is that it is important to separate the decision to make a
vaccine from the decision to use it. We have made the decision
because we have to in order to have the vaccine manufactured as
quickly as possible, to go forward with the manufacturing.
But the decision to start the vaccination campaign will
benefit from the additional information we can collect. If you
ask us--Do we expect there will be a vaccination campaign?--I
think the answer is yes. But the decision needs to await
additional information that we will collect in the Southern
Hemisphere and in the United States. That decision will be made
soon.
Chairman Thompson. Thank you very much.
I hope the point Mr. Pascrell made was not overlooked. It
is the committee's intention, based on GAO recommendations, for
some 3-month period of time, if at all possible, for you to
fully implement the recommendation. If not, the expectation is
you would indicate back to the committee which ones you are
unable to accomplish.
The gentlelady from New York for 5 minutes.
Ms. Clarke. Thank you very much, Mr. Chairman.
Thank you, Ranking Member.
This examination of the current status of H1N1 is so very
important right now. We are still hearing of occurrences not
only in our Nation, but around the world; and so it is very
timely that we address this now, particularly before we go into
our recess and come back towards the fall.
My question to both you, Mr. Corr, and to you, Dr. Lute,
has to do with the sale and movement actually of counterfeit
pharmaceuticals across our borders.
As you know, the sale and movement of counterfeit
pharmaceuticals across our borders into the United States is a
growing problem, and both of your agencies have been involved
in investigating cases involving these counterfeits, the FDA
under HHS and ICE of the DHS.
Can you talk about what the FDA and ICE, as well as CBP,
are doing to address counterfeit vaccine for H1N1 as well as
counterfeit antivirals and other medications that make
unsubstantiated claims to treat H1N1 influenza illness?
Ms. Lute. I might just begin by underscoring what you know
already to be true about the role of ICE in investigating any
suspected cross-border engagement of counterfeit
pharmaceuticals. This is very much a contingency that we are
aware of.
We recognize that there are certain incentives for groups
to profit from what we expect to be a major national incident,
come the fall; and we are very vigilant on that and working
together with our colleagues throughout the system to be sure
that we have complete--as complete as possible surveillance and
detection and interdiction and disruption and proper law
enforcement accountability, should that circumstance arise.
Mr. Corr. Congresswoman, I think that is a complete answer
certainly as far as the Food and Drug Administration and HHS
are concerned.
Ms. Clarke. I think that our vigilance is really going to
be important here, and unfortunately, there are those out there
who would exploit a situation like this. We already know that
in many instances, there is a big profit to be gained from
counterfeiting, and we just want to make sure that our
population is well-protected.
So we look forward to any finding that you may have about
any developments, any cooperation that you would be getting
from any of our partners across the border about any instances
that they may have encountered as they are beginning to deal
with the flu season in their respective areas.
My next question is about science and technology
challenges.
The committee is always on the lookout for new technologies
that will help us address the threats facing this Nation. But I
am kind of disappointed to see that we have not made further
progress in getting beyond the use of egg-based technologies
for vaccine production, still depending on that technology for
the H1N1 vaccine this time around. However, I am heartened that
the administration is supporting the development of new
technologies to create new vaccines, diagnostic tests, et
cetera.
Mr. Corr, could you tell us about the contract that HHS has
with Protein Sciences Corporation to develop its technique for
making influenza vaccines by growing flu virus proteins in
insect cells?
Dr. Lute, please discuss what DHS is doing to support
information via its Science and Technology Directorate.
Mr. Corr. Congresswoman, as you point out, the resources of
the Department, our advanced research resources, have focused
on developing new methods of making vaccines and other
products. I can't speak to you off the top of my head about
that particular methodology. We will get that information for
you.
But rest assured that we recognize that using egg-based
technology is not as efficient and as productive as we need. As
we move forward with this, it is a very important aspect of our
advanced development program to find other development
technologies that will produce more vaccine and at lower
prices.
Ms. Clarke. Thank you.
Ms. Lute. I would only add, Congresswoman, that we work
very closely with HHS and Science and Technology, along with
personnel and partnerships, forms the backbone of the
Department of Homeland Security's response to all risks and
hazards that the country faces.
While HHS has the lead on the medical side and the
scientific side, we are certainly attentive and alert to
technologies that enhance our ability to understand how risks
are approaching our shores, how we can more effectively
communicate the necessary actions people need to take. We will
stay in close coordination with our other colleagues,
especially HHS, as this season unfolds.
Ms. Clarke. Thank you very much.
Thank you, Mr. Chairman. I yield back.
Chairman Thompson. Thank you very much.
The Chair now recognizes the gentleman from Florida, Mr.
Bilirakis, for 5 minutes.
Mr. Bilirakis. Thank you very much, Mr. Chairman. This
question is to for Deputy Secretary Lute, Deputy Secretary
Corr.
In his written testimony, Mr. Farley, New York City's
Health Commissioner, stated the majority of individuals who die
each year in New York City from influenza are over the age of
65. As you may know, my district in Florida is home to a
significant elderly population, and the H1N1 strain of
influenza is particularly virulent.
How are you, how are your Departments working with the
State and local governments to provide outreach and information
to elderly and other special needs populations? What
recommendations are you making to State and local governments
as they work to prepare these populations? Who should be
vaccinated?
That is the question for the two of you. Thank you.
Ms. Lute. Mr. Chairman, with your permission, perhaps I
will begin as reaching out to State and local authorities and
municipalities.
From the very beginning, in the spring when this virus
presented itself, this was recognized by the Department, by the
Federal Government, as an important aspect of mobilizing any
national response to this virus; in other words, that we needed
to have the Federal Government tightly connected to State and
local authorities to ensure that the best information based on
the best science was put out in as timely a way as possible,
and that we had plain language guidelines that people could
follow. CDC and HHS have worked tirelessly to improve the
websites and to improve the content of the information and the
substance that is being put out to the public.
As I mentioned earlier, we have been giving daily e-mail
updates, twice weekly conference calls to the private sector,
which represents an important component of community life, we
recognize; weekly conference calls, e-mails, updates to State
and local authorities, a flu summit that was conducted so that
people were aware of the best knowledge that we had at the
time. A webcast is planned for August, and FEMA has been making
available planning templates and planning training as well.
Mr. Corr. Congressman, I would just add that one of the
challenges this flu season is going to be that we expect
seasonal flu to be circulating at the same time that H1N1 is.
From an elderly person's or a senior citizen's perspective,
H1N1, at least so far, appears to be more severe among younger
people, among children and younger people that have other
underlying conditions. It doesn't seem to be as severe in
senior citizens. It may be because of some partial immunity
developed from the swine flu in 1976 or earlier flus that they
were exposed to.
This just points up, though, the incredible importance of
communicating clearly to the public through our work with the
State and local and Tribal and territorial health departments,
as Secretary Lute was saying, so that people understand how
important it is to get their seasonal flu shot and to get their
H1N1 shot.
So we will be endeavoring to make sure the public
understands what they need to do.
Mr. Bilirakis. With regard to the younger people, my
State's acting epidemiologist has said that as many as 5
million Floridians could contract the H1N1 virus within the
year if the virus follows the pattern of previous pandemics.
There have been at least 22 deaths in my State of individuals
who had the H1N1 virus. I am especially concerned that the
number of cases in Florida will skyrocket when schools begin in
the fall.
Since this virus has disproportionately, as you said,
affected school-age children, would each of you please comment
on the following questions:
What recommendations should we provide parents of school-
age children in my district about how to protect their children
from this virus;
Should children with this virus stay home from school;
Should school administrators close schools;
Which schools have become infected with this virus; and,
Are there uniform recommendations about how long schools
should remain closed under such circumstances?
If you could address those--one more--what Federal
Department or Agency is the lead authority when it comes to
such guidance?
Thank you very much.
Ms. Lute. Again, Mr. Chairman, with your permission, I
might just begin in response.
The issue of schools and school closures was one of the
things that we learned during the spring. This is, as you
rightly point out, a source of quickly spreading the disease
among--the virus among young people. So we are very aware of
the importance of getting good guidance out, again, based on
the principle of the best scientific knowledge and evidence.
We are in the process of formulating, with the Department
of Education and our colleagues from CDC and Health and Human
Services, that guidance, so that it can be promulgated and that
school administrators can have a plain-language--access to
plain-language instructions for making those decisions on a
school-by-school and municipality basis.
Mr. Corr. Congressman, I would just add that it is very
important for parents to explain to their children some basic
steps they can take that will protect them. It is the same
instructions, really, for all of us, which is that if you are
coughing or sneezing, you cough into your arm; that if you are
sick, you stay home, that you wash your hands frequently; do
not touch your eyes, nose or mouth. Those basic steps can make
a huge difference in the transmission of the virus.
Having said that, the guidance that Secretary Lute talked
about and worked with the school systems are very important for
them to understand what steps they should take as the exposure
to the virus spreads.
Chairman Thompson. The gentleman's time has expired.
The gentleman from Texas, Mr. Cuellar, for 5 minutes.
Mr. Cuellar. Thank you, Mr. Chairman. This question is to
Dr. Lute and Mr. Corr.
How has the pandemic influenza National planning scenario
informed you of your plans and response efforts, question No.
1? The second part is, have your agencies considered how a
pandemic could be taken advantage of by terrorists and how do
you respond under that particular scenario?
Ms. Lute. With your permission, Mr. Chairman, I will begin.
The National scenarios provide a basis and a foundation for
understanding how to approach with best planning needs and
understanding the gaps that exist in the state of our National
preparedness to deal with this.
We have learned a lot, I would like to underscore, Mr.
Chairman, about this pandemic and how we could--we should
respond to it, the state of readiness that exists in the
Federal Government, at the State and local level, what
knowledge gaps exist and what tools are necessary so that
individuals can be empowered, communities can be capable of
dealing with the scenarios that may unfold, and the Federal
Government is responsive to meet their needs.
We have also--in the Department of Homeland Security we
remain vigilant every single day about the potential for
terrorists to exploit any set of circumstances which they may
perceive as a vulnerability. This virus will not represent a
vulnerability for terrorists to exploit. This is a
circumstance, it is a public health circumstance; it is Nation-
wide.
It is unique; we are taking, in some cases, unique
measures. For example. We are deploying regional coordination
teams which will focus on pandemic preparedness and response to
allow the other elements of the Homeland Security family to be
able to focus on their responsibilities in maintaining
vigilance and leading the American effort to protect ourselves.
Mr. Corr. Congressman, I would just add that looking back
at the preparedness planning that has gone on, as the GAO did,
is very helpful in recognizing where we still have gaps. But we
are learning first-hand a great deal about how to prepare for
and implement our plans. I think that as we work our way
through this, we are going to be able to substantially enhance
and improve our long-term planning for pandemics of other
types.
Mr. Cuellar. Thank you.
Dr. Lute, let me focus on Customs Border Protection folks,
which are the men and women in blue, as you know, on the border
area. If they don't have a sufficient--well, let me ask you,
let me put it this way.
Are they sufficiently qualified to determine who might
display symptoms of a particular illness, No. 1?
No. 2 is, what protection are we giving to those men and
women at the border?
Ms. Lute. Congressman, these extraordinary men and women
who police our borders and provide the protection and the
secure borders that the American people have a right to expect
conduct screening of individuals every day as they cross. They
are not medical doctors, equipped with the expertise that
doctors do have to be able to specifically identify symptoms
and the underlying condition which may give rise to those
symptoms. But we have a very close working relationship with
CDC, as you know, so that when individuals are identified that
may present particular symptoms and conditions, they can be
referred for additional screening and appropriate action as
necessary.
Mr. Cuellar. I do understand that they are not M.D.s. I do
understand that you have got resources. But I guess my question
is, what sort of training have they gotten to identify those
symptoms?
Ms. Lute. We have conducted training of the Customs Border
as well as our Transportation Security officers on H1N1, the
symptoms that present themselves. It is important to recognize
that the virus can be present and a person can be asymptomatic
for a period of time. Again, we rely on medical advice and
assistance for this purpose.
But we screen every day, and we are adding this information
to their skill set as they perform their duty.
Mr. Cuellar. Thank you, Dr. Lute.
Mr. Corr and Ms. Steinhardt, I appreciate what you do at
the GAO with the strategic work. Thank you.
Thank you, Mr. Chairman.
Chairman Thompson. Thank you very much.
I would like to thank our first panel of witnesses for
their valuable testimony and Members for their questions.
Before being dismissed, I would remind our first panel of
witnesses that the Members of the committee may have additional
questions for you, and we ask that you respond expeditiously in
writing to those questions.
I would like to ask the clerk to prepare the witness table
for our second panel of witnesses; and again, thank our first
panel of witnesses for their very valuable testimony.
We have been told that we have another series of votes, and
I am going to try to get through the witness statements first,
and then we will come back to questions and we will go right
into the questions.
I would like to welcome our second panel of witnesses. Our
first witness, Ms. Colleen Kelley, is president of the National
Treasury Employees Union.
Our second witness is Mr. Richard Muth. Mr. Muth is
director of the Maryland Emergency Management Agency.
Our third witness is Dr. Mark Horton. He serves as the
California State health officer and as the director of the
California Department of Health.
The fourth witness is Dr. Thomas Farley. Dr. Farley is
health commissioner for New York City.
We thank our witnesses for their service to their States
and to the Nation and for being here today. As previously
stated, each witness's full statement will be inserted in the
record. I now ask each witness to summarize his or her
statement for 5 minutes, beginning with Ms. Kelley.
STATEMENT OF COLLEEN M. KELLEY, PRESIDENT, NATIONAL TREASURY
EMPLOYEES UNION
Ms. Kelley. Thank you very much, Chairman Thompson and
Ranking Member King and committee Members. I appreciate the
opportunity to testify on behalf of thousands of employees
represented by NTEU, who work every day to protect our country
from threats and who have continued to do their critical work
diligently during the on-going H1N1 flu outbreak.
This outbreak has raised serious concerns about how the
Federal Government creates and communicates policies to protect
the health of front-line Federal personnel. Most troubling to
NTEU is that key stakeholders, including Federal employees and
their employee representatives, are not consulted in the
development of pandemic response strategies. We have not had
the opportunity to participate in the development of or comment
on the November, 2005 National Strategy for Pandemic Influenza
and the May 2006 Implementation Plan.
NTEU commends you, Mr. Chairman, for recognizing this
glaring weakness in the committee's January 2009 report Getting
Beyond Getting Ready for Pandemic Influenza and for calling on
the new administration to address this shortcoming.
The NTEU members at the Department of Homeland Security
most affected by the outbreak of the H1N1 influenza are Customs
and Border Protection officers and agriculture specialists who
work at the land, sea, and air ports of entry and
Transportation Security officers who work at the airports. Both
groups of employees interact with thousands of travelers in a
single shift. Their work includes reviewing immigration
documents, wanding passengers, questioning them and sometimes
patting them down or detaining them. It requires them to be
within 6 feet of the travelers that they process.
The CDC's general guidelines of avoiding crowds and
maintaining a distance of 6 feet from those exhibiting illness
is clearly not possible for these DHS employees who are at
increased risk of exposure. Specific guidance must be developed
and communicated clearly and in writing to them.
For the past 3 months, NTEU has repeatedly requested clear,
written guidance from DHS with respect to the voluntary use of
personal protection equipment, including N95 masks for these
front-line employees at CDC and TSA. Because of the Agency's
reluctance to issue clear and written voluntary use guidance,
NTEU worked with Congress on this critical subject. On June 4,
the full House approved an NTEU-supported amendment to the TSA
Authorization Act that requires TSA to allow personnel to
voluntarily wear PPE during an emergency.
House appropriators also added NTEU-supported language to
the fiscal year 2010 DHS appropriations bill, which ensures
that DHS personnel may voluntarily use PPE, including masks,
without being subject to discipline. We appreciate this
committee's support on these efforts and its continued focus on
pandemic preparedness, particularly with regard to the impact
on the Federal workforce.
NTEU believes that congressional involvement has helped to
move Homeland Security to begin to clarify and communicate its
guidance. On May 29, TSA issued policy guidance on PPE that is
clear and allows TSA's discretionary use of the N95 masks; but
the May 29 TSA guidance was not initially shared with TSA
employees, and according to our Members, was only recently
distributed to TSA personnel, just 10 days ago. This delay in
publicizing the TSA PPE voluntary use guidance is very
troubling.
With respect to PPE guidance at CBP, after initially
prohibiting voluntary use, I am pleased to report that just a
few hours ago, NTEU signed an agreement with CBP to permit
employees the option, at their discretion, of donning
protective masks including the N95 respirators. NTEU's
experience with Homeland Security during the initial and
continuing outbreak of H1N1 influenza highlights the need for
open and frank communication between all Federal agencies,
their employees and their employee representatives.
A resurgence of the H1N1 flu is expected in the fall, as we
know, and important issues must be addressed now that will
impact all Federal workers, but especially those on the front
line who, by the very nature of their jobs, work in close
contact with huge numbers of travelers who may be infected.
Therefore, NTEU makes the following recommendations:
No. 1, that a determination must be made as to whether some
Federal workers should receive priority in a vaccination
distribution;
No. 2, that Federal leave policies must be clear,
especially in the case of working parents who may have a sick
or quarantined child or a child whose school or day care is
closed;
No. 3, social distancing is a key factor in preventing the
spread of the flu, and for this reason Federal telework
programs must be up and running to facilitate continuity of
operations;
No. 4, in the case of substantial reduction of personnel
due to illness, shifting of job location and duties of Federal
personnel may be necessary to maintain operational control;
shift extensions, overtime, cancellation of leave and travel
requirements will be critical in order to address a pandemic-
induced reduction in the Federal workforce; and
No. 5, clear written personnel policies must be in place to
address these contingencies, and frequent, updated
communication with the Federal workforce and Federal employee
representatives is absolutely essential.
Thank you again for the opportunity to testify, and I look
forward to any questions.
[The statement of Ms. Kelley follows:]
Prepared Statement of Colleen M. Kelley
july 29, 2009
Chairman Thompson, Ranking Member King, distinguished members of
the Committee: I would like to thank the committee for the opportunity
to provide this testimony. As President of the National Treasury
Employees Union (NTEU), I have the honor of leading a union that
represents hundreds of thousands of Federal worker including thousands
of Transportation Security Officers (TSOs) at the Department of
Homeland Security's (DHS) Transportation Security Administration (TSA)
and 22,000 Customs and Border Protection (CBP) Officers, Agriculture
Specialists (CBP AS) and trade enforcement specialists who are
stationed at 327 land, sea, and air ports of entry (POEs) across the
United States. TSOs, CBP Officers and CBP AS make up our Nation's first
line of defense in the wars on terrorism, drugs, contraband smuggling,
human trafficking, agricultural pests, and animal disease while at the
same time facilitating legitimate trade and travel.
Employees on the frontlines of our Nation's borders and airports
are exposed to many threats, the newest being exposure to the H1N1
influenza. On Wednesday, April 22, 2009, the first reports of H1N1 flu
exposure in the United States became public and the press began
reporting on a swine flu outbreak originating in Mexico. To date, it is
suspected that there have been as many as 2 million H1N1 flu cases in
the United States. H1N1 flu outbreaks are documented daily. Currently,
at the U.S. Coast Guard Academy in New London, Connecticut, over 10
percent of the freshman class has H1N1 flu.
This outbreak has raised serious concerns about how the Federal
Government creates and communicates policies to protect the health of
key frontline Federal personnel. Most troubling to NTEU, is that key
stakeholders, including Federal employees and their employee
representatives, are not being consulted in the development of pandemic
response strategies and had not been afforded the opportunity to
participate in the development of or comment on the November 2005
National Strategy for Pandemic Influenza and the May 2006
Implementation Plan. NTEU commends the Chairman for recognizing this
glaring weakness in the committee's January 2009 report entitled,
``Getting Beyond Getting Ready for Pandemic Influenza'' and for calling
the new administration to address this shortcoming. I applaud the
Homeland Security Committee for holding this timely hearing.
Policies to mitigate health risks for Federal employees should vary
according to the type of work being done and the potential for
exposure. The general guidelines, which include staying out of crowds,
do not adequately address situations where an employee's entire work
shift requires him or her to be in close contact (within 6 feet) of
literally thousands of travelers, which is the case for Transportation
Security Officers, Customs and Border Protection Officers, and
Agriculture Specialists.
Specific guidance must be developed and communicated clearly and in
writing to these employees who are at increased risk of exposure. It is
unacceptable and shocking that more than 3 months after the initial
onset of H1N1 flu in the United States and despite repeated urging from
NTEU and others, there is still no comprehensive guidance in place to
protect the health of these frontline employees.
The September 2007 CBP Operations Plan for Pandemic Response states
that ``CBP is the first line of our Nation's defense against a
pandemic, both overseas and along our border.'' This plan was
formulated in response to the possible outbreak H5N1 avian flu
pandemic. According to this plan, ``CBP could experience a substantial
reduction of personnel due to illness (approximately 30% to 50%),
potentially having a substantial impact on sustaining continuity of CBP
operations . . . Once a pandemic begins to spread, significant numbers
of infected travelers at and between the POEs may be searched,
detained, transported, and housed by CBP pending removal or transfer
into the custody of medical authorities, impacting CBP's ability to
perform its mission . . . In spite of this, CBP must continue to carry
out its priority mission to prevent the entry of terrorists and their
weapons, regardless of the circumstances. To accomplish this, CBP will
need to protect its workforce . . . ''.
It was therefore extremely troubling to NTEU that DHS issued
conflicting and confusing guidance to frontline CBP Officers and TSOs
during the initial H1N1 spring outbreak. Shortly after the swine flu
outbreak became public in late April 2009, NTEU started receiving
questions from our members at ports of entry around the country. In
numerous locations, personal protection equipment (PPE), including
gloves and N-95 respirators, was distributed to employees. At JFK
Airport in New York, for example, distribution to CBP employees began
on April 25 and continued through April 26 with little guidance. In the
afternoon of the 26th employees were initially told they were only to
wear the respirators if in contact with an ill individual. Later they
were told they were not to wear the respirators at all, so as not to
alarm the public or offend passengers.
On April 26 Homeland Security Secretary Napolitano sent a message
to DHS employees working near the Southwest border. That message
stated: ``CDC recommends that a distance of 6 feet should be maintained
between all employees and someone who appears ill. The use of N95 masks
is suggested if an employee must maintain closer contact than the 6
feet of distance.''
On April 28, a CBP spokesperson was quoted in CNSNews.com saying,
``CBP officers and Border Patrol agents are provided personal
protection gear which they may utilize at their discretion.''
On April 30 a DHS spokesperson was quoted in a media report saying,
``the Department of Homeland Security has not issued an order saying
our employees cannot wear masks.''
Transportation Security Officers at Dallas/Fort Worth Airport were
issued masks on April 26 and on the 28th told they could not wear them
unless they were dealing with a traveler exhibiting swine flu symptoms.
According to a press report in the Washington Times on May 2, a TSA
PowerPoint presentation was distributed to TSA employees on April 29
that stated: `` . . . the routine wearing of protective masks by TSA
personnel in the workplace is not authorized . . . In addition to not
being medically necessary, the masks interfere with normal
[transportation security operation] duties and hold the potential for
unnecessarily alarming the public . . . ''.
NTEU requested a copy of the PowerPoint presentation, but was told
it was not available for public distribution.
As soon as questions began coming in to NTEU from our members
around the country as to whether they could wear respirators or masks,
NTEU began trying to find out what the current policy was and urged
that these employees be allowed to wear the masks if they felt their
health was at risk. We contacted CBP, TSA, and DHS. DHS was saying it
had not issued a Department-wide order prohibiting the voluntary
wearing of masks, but CBP and TSA were clearly enforcing such a
prohibition.
Some statements from DHS that appeared in the press indicated that
managers who were preventing the wearing of masks were misinformed
about the actual policy. The idea that a few managers were misinformed
is clearly not accurate. NTEU heard from many, many employees from
around the country and attached to this testimony are affidavits from
some of them relating instances of supervisors demanding that they
remove respirator masks.* Many of them are disturbingly threatening and
many include comments indicating the reason was fear of alarming the
public. I trust this committee will ensure that the employees providing
these affidavits will be free from any negative impact.
---------------------------------------------------------------------------
* The information has been retained in committee files.
---------------------------------------------------------------------------
On April 30, DHS issued Interim Guidance stating that: ``Employees
who work closely with (either in contact with or within 6 feet of)
people specifically known or suspected to be infected with the H1N1
virus must wear respiratory protection.'' The guidance did not address
the question of the voluntary donning of masks. In addition, the
Interim Guidance noted it was being released ``as an interim measure
until the Office of Personnel Management provides comprehensive
guidance for all Federal employees.'' OPM has since indicated it does
not intend to provide such Government-wide guidance, stating that on
questions such as this, affecting narrow segments of the workforce,
decisions are up to the individual agency.
On May 1, I wrote to DHS Secretary Napolitano and OPM Director
Berry urging that written guidance be issued immediately clarifying
that these frontline employees would be allowed to wear masks at their
discretion. On May 5, CBP Acting Commissioner Ahern sent out an
employee message reiterating the mandatory use of respirators when
employees were in close contact with people known or suspected to be
infected with the H1N1 virus. The message included no reference to the
voluntary wearing of respirators despite NTEU's repeated requests to
CBP for such guidance.
On May 8, I sent a second letter to Acting TSA Administrator
Rossides and a letter to Acting CBP Commissioner Jayson Ahern asking
again for written guidance that these employees be allowed to wear
respirators/masks at their discretion.
On May 14, 2009, I testified before the House Committee on
Oversight and Government Reform Subcommittee on the Federal Workforce,
Postal Service and District of Columbia about the Department of
Homeland Security's (DHS) refusal to allow Customs and Border
Protection (CBP) and Transportation Security Administration (TSA)
employees to wear a respiratory mask, if they so choose, to help
protect them from infection from the swine flu virus.
At the hearing, Subcommittee Chairman Stephen Lynch (D-MA) offered
to work with NTEU on legislation if this situation was not quickly
corrected by the Department. On Friday, May 29, the Department of
Homeland Security Under Secretary for Management, Elaine Duke, issued
an updated guidance regarding the use of Personal Protective Equipment
(PPE), as it applies to working in close proximity to persons
exhibiting symptoms of the H1N1 virus. But again, the guidance failed
to provide a clear and reasonable policy allowing for the donning of a
mask at your discretion in situations not involving close contact with
an apparently infected person. On June 1, I sent a letter to DHS Under
Secretary Duke seeking clarification of the May 29 guidance.
On June 4, the House of Representatives passed H.R. 2200, the TSA
Authorization Act. On the House floor, Representative Lynch offered an
amendment to provide that any TSA personnel may voluntarily wear
personal protective equipment (including surgical and N95 masks,
gloves, and hand sanitizer) during any emergency. NTEU worked closely
with Representative Lynch and strongly supported this amendment. The
Lynch amendment was passed by voice vote and became part of the bill.
The bill now goes to the Senate for consideration.
Unfortunately, H.R. 2200 was limited to TSA-related provisions;
therefore, the amendment does not address the discretionary use of PPE
by CBP Officers and CBP Agriculture Specialists at the ports of entry
that also daily come into close contact with thousands of travelers
transiting into the United States.
On June 16, NTEU testified before the Senate Homeland Security and
Governmental Affairs Subcommittee on Oversight of Government
Management, the Federal Workforce, and the District of Columbia on this
issue. NTEU asked the committee to include similar language to the
Lynch amendment in any upcoming legislation that includes CBP
jurisdiction.
Working with House Appropriators and Representative Lynch, NTEU got
language in H.R. 2892, the fiscal year 2010 DHS House appropriations
bill that would allow DHS personnel the discretionary use of masks
without being subject to discipline.
Also, NTEU serves on the Federal Advisory Committee on Occupational
Safety and Health (FACOSH). NTEU believes that the Occupational Safety
and Health Administration has the expertise to formulate the pandemic
flu workplace health and safety response and submitted a resolution to
that effect at their scheduled meeting in June. As a result, a FACOSH
work group was established to address emerging worker health and safety
issues, including the voluntary use of PPE by Federal workers,
surrounding the H1N1 flu.
Despite these continued efforts, CBP issued a new guidance on June
17, 2009 that stated that ``employees may use the personal protective
equipment (PPE) in situations where they believe it is needed to safely
carry out their duties.'' This guidance, however, was followed by
management guidance on June 19 that stated ``Any employee who feels it
is necessary to don PPE to perform their normal duties, must first
contact their immediate supervisor . . . If after consultation with
their supervisor the employee still has concerns, the employee will be
allowed to wear PPE . . . Each request to don PPE must be considered on
a case by case basis by CBP management.''
NTEU met with DHS and CBP officials on July 14 and raised this
contradictory language and asked them to agree to a Memorandum of
Understanding (MOU) with us that is clear and unambiguous. On July 23,
NTEU received a proposal that we believe will be acceptable to our
members. As of the submission of this testimony, NTEU and CBP appear
close to an agreement.
Unlike the June 19 CBP guidance, on May 29, 2009, TSA issued Policy
Guidance on Personnel Protective Equipment that is clear and allows
TSOs discretionary use of N95 masks. But the May 29 TSA guidance was
not shared with TSA employees and, according to TSOs, was only just
distributed to TSA personnel after the reported H1N1 flu-related death
of a TSO at the San Juan Airport on July 19.
These experiences with DHS during the initial and continuing
outbreak of H1N1 influenza highlights the need for open and frank
communication between Federal agencies, their employees, and their
employee representatives. The U.S. Government expects a resurgence of
the H1N1 flu strain in the fall and continues to prepare for the
upcoming 2009-2010 winter flu season. The timing, severity, and the
geographic location of the resurgent H1N1 influenza remains unknown,
but important issues must be addressed now for all Federal workers,
especially those on the frontline who are responsible for keeping our
air, sea, and land ports open to trade and travel. Those issues
include:
(1) Clear guidance is needed as to whether some Federal workers
should receive priority when a vaccination is approved and
distributed to the public.
(2) Federal leave policy must be clear, especially in the case of
working parents who may have a sick or quarantined child or a
child whose school or daycare is closed.
(3) Social distancing is a key factor is preventing the spread of
flu. For this reason, Federal telework programs must be up and
running to facilitate continuity of operations.
(4) In the case of substantial reduction of personnel due to
illness, shifting of job location and duties of Federal
personnel may be necessary to maintain operational control.
Shift extensions, overtime, cancellation of leave, and travel
requirements will be critical in order to address a pandemic-
induced reduction in the Federal workforce.
(5) Clear written personnel policies must be in place to address
these contingencies and frequent, updated communication with
the Federal workforce and Federal employees' representatives is
absolutely essential.
NTEU appreciates the committee's continued focus on pandemic
preparedness and its insistence on common-sense guidance with respect
to protecting frontline DHS personnel and the entire Federal workforce.
NTEU pledges to work with Congress and our agency partners to address
the personnel challenges of a potentially severe pandemic and help to
ensure the continuity of Federal services.
Thank you again for holding this important hearing.
Chairman Thompson. Thank you very much for your testimony.
We now recognize Mr. Muth for 5 minutes.
STATEMENT OF RICHARD G. MUTH, EXECUTIVE DIRECTOR, MARYLAND
EMERGENCY MANAGEMENT AGENCY
Mr. Muth. Good afternoon, Chairman Thompson, Ranking Member
King and Members of this committee. Before being appointed to
my current position, I served in the Baltimore County Fire
Department for over 30 years, including 15 years as the
county's Emergency Manager. I thought that was important to
say, because I come here today representing both the State
government but also with much experience at the local level.
It is an honor to be invited here today to discuss
Maryland's current preparedness and response activities for the
H1N1 and the critical issues that remain a challenge for the
future.
A pandemic flu response presents a set of challenges are
that different from other emergencies. Since the last severe
pandemic in the United States happened about 90 years ago, we
don't have any hands-on experience dealing with one; and unlike
most emergencies, especially declared disasters, it does not
have a well-defined beginning and ending. It does not have
geographic limitations and potentially lasts much longer.
We have experienced a relatively mild spring outbreak, but
experts tell us the fall flu season will be much worse.
Maryland is committed to using all available resources and
personnel to address the situation.
This committee's majority staff report identified four
major categories of action items to strengthen: Establish
effective management, address and meet key medical
requirements, evaluate update plans, and improve early warning
and detection. Here are some of Maryland's accomplishments in
these areas, or plans in our areas that we are still working
on:
First, Governor Martin O'Malley instructed the Maryland
Department of Health and Mental Hygiene in my agency to lead an
H1N1 leadership task force to address some of these issues,
determine who is in charge, integrate the response in the
incident command system and improve communications among
various State and local agencies and with the public.
Next, the Governor mandated State agencies' Continuity of
Operations Plans to be updated and completed by October 1,
along with updated pandemic flu operational plans and our
Strategic National Stockpile plan. Just 2 days ago, we hosted
the H1N1 summit to ensure open dialogue between public health
and school officials, emergency medical providers, and local
emergency managers.
While we are working diligently to prepare for a possible
pandemic as schools return to session next month and as the
traditional flu season hits later in the fall, we have
identified several issues that must be addressed at the Federal
level either by Congress or the administration.
First, leadership and coordination issues must be resolved
at the Federal level, which will give the States more
confidence in the guidance we receive from the Department of
Health and Human Services and the Department of Homeland
Security and other Federal partners. There may have been
legitimate political and logistical reasons for having HHS and
DHS as the Federal voices of H1N1, but that may have confused
the public, and while the leadership issue may have been
resolved at the Federal level, that resolution need to be
communicated to the States.
I had the opportunity to speak to some of my peers across
the country, and they all had the same concerns that we had; so
this communication certainly needs to be worked on.
It is vital that all agencies use the incident command
system. Failure to use this consistent common language in
commands can delay the coordination of resources and may
endanger both responders and the general public.
It is important that the public receive timely, credible,
and definitive guidance from the Centers for Disease Control.
For example, the radical change in school closing guidance
several days into the spring pandemic clearly colored the
public's perception of Government decisions.
Second, as was shown with both the inaugural activities
last January and the spring H1N1 outbreak, it may be time for
legislative review of the Stafford Act to help make sure it is
appropriate to deal with today's events and their potential
enormous cost. The Stafford Act was designed to deal with
disasters like tornadoes and hurricanes, but it does not work
so well with emergencies that don't have a definitive ending
date or may have a lull of several months between activities,
such as we are seeing now with the pandemic.
We need Federal guidance about what types of disaster
assistance might be available for responding to a pandemic and
what thresholds are required for a disaster declaration. In
this economic climate, States cannot afford to guess at what
may or may not qualify for assistance.
Third, State and local governments need greater flexibility
to use various Federal grants to help with H1N1 prevention and
response. Protection for first responders and workers in the
medical field needs to be one of the top priorities. I am
asking that Congress and the administration develop a new
funding source so that these front-line workers can be supplied
with appropriate personal protective equipment.
It is also vital that these grants allow States the
flexibilities to manage their own need. One-size-fits-all does
not always fit all.
Finally, we must have consistency between public health and
emergency management planning guidance so that the various
agencies can work together seamlessly. Not only is the current
guidance inconsistent with established emergency management
guidance, it does not allow for the needed flexibility or
scalability for each State or situation. The spring outbreak,
for example, while it was a fast-spreading, novel virus, it did
not seem to have the high mortality of previous pandemics.
However, much of the planning guidance was based on the high
mortality pandemics in 1918 and 1919.
In addition, I would like to mention one other area of
concern. I sit on a subcommittee of National Children and
Disasters, and one area they have is that the children not be
forgotten in all areas, including planning and any type of
inoculation.
So I thank you for giving me the opportunity to discuss
these important issues today.
[The statement of Mr. Muth follows:]
Prepared Statement of Richard G. Muth
July 29, 2009
introduction
Chairman Thompson, Ranking Member King, and Members of the
committee, my name is Richard Muth and I am the Executive Director of
the Maryland Emergency Management Agency. It is an honor to be invited
here today to discuss Maryland's current preparedness and response
activities for the H1N1 pandemic influenza and the critical issues that
remain a challenge for the future.
What is the Maryland Emergency Management Agency?
The Maryland Emergency Management Agency (MEMA) is mandated under
State law to ensure that the State is prepared to deal with all
emergencies, especially those that exceed the capabilities of the local
jurisdictions, and to coordinate the overall State's response in a
declared emergency or major disaster. In addition to supporting the
local governments, MEMA coordinates assistance with the Federal
Emergency Management Agency (FEMA) and other Federal partners when the
Governor declares a state of emergency and receives a Presidential
disaster declaration. While MEMA is part of the Maryland Military
Department and under the authority of the Adjutant General, during
emergencies the Governor assumes direct authority over the Agency and
the Executive Director of MEMA reports directly to the Governor.
A key element within MEMA is the Maryland Joint Operations Center
(MJOC). Operated round-the-clock by National Guard and MEMA employees,
it is a joint civilian-military watch center. In addition to serving as
a communications hub for emergency responders State-wide and supporting
local emergency management, the MJOC monitors local, State, national,
and international events, including weather, and advises decision-
makers in Maryland when a situation warrants.
MEMA coordinates the States' response to an emergency at the State
Emergency Operations Center (SEOC) in Reisterstown, Maryland. When the
SEOC is fully activated, each State agency, as well as some Federal
agencies, private sector, and volunteer organizations sends a
representative to the SEOC with authority to make decisions and
allocate needed resources and funds to response efforts on behalf of
their agency.
MEMA also serves as the State administrative agent for all homeland
security grants received from the Federal Government.
Pandemic flu response presents challenges distinguishable from most
emergencies.--There are a few aspects of pandemic flu that distinguish
it from other emergencies that States and localities are accustomed to
handling. The nature of this type of event is new and unfamiliar to
almost all Americans because the United States has not experienced nor
witnessed a severe flu pandemic since 1918-1919. With little to no past
experience to guide us outside of history books, aspects of our
response efforts have to be revised and reconsidered. The unknown
duration and potentially long-term nature of this novel event also
creates enormous resource strains, especially in an environment of
budget deficits.
As we approach the fall, States and localities will have to balance
competing priorities: Meeting the demands of a flu of unknown duration
and severity, ensuring the ability to manage the needs of other
emergencies (such as a possible hurricane), and continuing to provide
basic and essential Government services to the public. The response and
implications of pandemic influenza are not simply a public health or
individual medical issue. The health response will require an increase
in resources, coordination, and support from all levels and sectors of
government while at the same time will create a severe reduction in the
available government and private workforce. Pandemic influenza has the
potential to severely impact every aspect of our economy.
The Committee on Homeland Security Majority Staff Report, ``Getting
Beyond Getting Ready for Pandemic Influenza'' identified four major
categories of action items to strengthen response: (1) Establishing
effective management and coordination; (2) addressing and meeting key
medical requirements; (3) evaluating and updating plans; and (4)
improving early warning and detection. Maryland strongly agrees with
these recommendations and is currently taking steps to complete these
actions. I will highlight some of our accomplishments, future
intentions, and remaining gaps in these four areas.
1. establishing effective management and coordination
On June 24, 2009, Maryland Governor Martin O'Malley hosted a State
after-action meeting to discuss and evaluate Maryland's initial
response to the H1N1 outbreak. As a result of the information gleaned
from this meeting, Governor O'Malley immediately established an H1N1
Leadership Task Force. This Task Force is co-chaired by the Secretary
of the Department of Health and Mental Hygiene (DHMH) and me and
includes executive level personnel from all relevant State agencies. To
ensure that Maryland is prepared to respond effectively to H1N1 this
fall, the Task Force has been assigned specific action items and a 45-
day timeline to report back to the Governor on the ways in which it has
corrected gaps and resolved issues. This Task Force has been charged
with the following deliverables:
1. Resolve any issues involving implementation of the unified
command/incident command system during public health
emergencies; the number, location, and staffing of operations
centers; and the use and implementation of a Joint Information
Center.
2. Ensuring that the States' Pandemic Flu, Strategic National
Stockpile (SNS), and Mass Vaccination plans are completed and
have been reviewed and signed by all agencies to ensure they
understand and can execute their roles during an emergency.
3. Identifying a date within 60 days to convene meetings among
State and local leadership such as local public health
officials and emergency managers, school officials, emergency
medical service providers, and/or hospital leadership and local
elected officials to ensure a two-way dialogue and discussion
regarding communications and response to fall H1N1 operations.
4. Determine whether reconsideration of State-wide human resource
and personnel policies (leave, tele-work, and on-call
situations) for public health emergencies is needed, and as
appropriate, develop and implement these policies.
5. Pre-identify trigger points and guidance for State agencies to
activate their pandemic influenza Continuity of Operations
Plans (COOP).
6. Pre-identify optimal procedures, combinations, and sequences for
requesting a Stafford Act emergency, public health emergency,
and authoring emergency powers in conjunction with H1N1.
7. Develop a streamlined system to ensure comprehensive and
consistent internal communications across State agencies and
externally with local partners which can be applied to all-
hazard situations.
8. Conduct an exercise of the State's plan for mass distribution of
an H1N1 vaccine, as well as any other aspects of the State's
pandemic influenza plan deemed in need of exercise by the
taskforce.
9. Provide an assessment of local jurisdictions and private sector
partners' readiness.
By identifying and demanding timely action on these issues,
Maryland will increase its ability to respond to a potentially more
severe wave of H1N1 this fall. Many of these action items will address
critical components of effective management and coordination for future
response. However, there is additional assistance and clarity that
could be provided by the Federal Government to assist us with our
efforts.
All Federal Government Agencies must use the Incident Command
System (ICS) and provide a consistent message to the States regarding
who is in charge during a public health emergency:
It is the State's policy to coordinate, to the extent possible, all
emergency management functions of the State with the comparable
functions of the Federal Government. Despite State mandates to use the
incident command system (ICS), it does not appear to the States that
all Federal agencies have fully adopted or institutionalized its use,
particularly within the Department of Health and Human Services (HHS).
Traditionally, first responders, fire, police, Emergency Medical
Services, etc. understand and use ICS every day. There appears to be
confusion with other agencies as to the use of and fully understanding
of this system. One of our first lessons learned from the event last
spring was that, in the future, we must use the ICS standard as soon as
practical because failure to use it can cause inconsistent commands
across government, can delay the coordination of resources and
information, and may endanger responders and the safety of the public.
We know that moving forward, it must be clear to all stakeholders
that DHMH is the lead response agency in a public health emergency and
MEMA is the lead coordinating agency. The roles are analogous to that
of an airline pilot and air traffic control tower. An airplane pilot is
responsible for the safe takeoff, flight, and landing of an aircraft.
To successfully accomplish these tasks, an airplane pilot needs to
receive a steady stream of information on weather conditions and other
traffic in the area to make appropriate decisions on how to fly the
plane. The air traffic control tower is responsible for maintaining
situational awareness, coordinating any needed resources, and providing
the pilot with the information required to fly the plane in a skillful
manner. These roles are similar to that of DHMH and MEMA in a public
health emergency. MEMA will maintain situational awareness of the
conditions of the emergency throughout the State and coordinate this
information with DHMH so it can use its subject matter expertise to
make effective decisions on responding to the emergency. This division
of roles must be the same at the Federal level between HHS and DHS.
There continue to remain questions and inconsistent messages about
whether HHS or DHS is in charge of the response to a public health
emergency at the Federal level. In July, the DHS Secretary Napolitano
and HHS Secretary Sebellius held a H1N1 Summit with the States. Even at
this event, it was not clear to participants about the differences in
roles and responsibilities between HHS and DHS in pandemic influenza.
For example, DHS has a new initiative of H1N1 Field Response Teams and
the States would like to know how these will be used in the most
effective manner.
During the spring incident, guidance and information from the
Centers for Disease Control (CDC) was disparate, sometimes confusing,
and constantly changing, especially as it applied to recommendations on
school closings. When guidance from the Federal Government changes
frequently, it affects the public's perception of the Government's
control of the event and impacts the likelihood that the public will
comply with Government's decisions and recommended advice. While the
constantly changing decisions were only somewhat understood this past
spring due to the new and unknown nature of H1N1, it is critical this
fall that States receive timely, definitive guidance from the Federal
Government, especially on recommendations for school closings. The
authority to close schools within Maryland depends on the nature of the
emergency. To avoid delay and confusion during times of emergency, the
Maryland State Department of Education (MSDE) and DHMH recently signed
a Memorandum of Understanding to clarify their respective roles when an
emergency requires the closing of public and non-public schools.
It is extremely important that the public perceive that governments
are relying on the same credible information before making decisions.
This is of particular importance in Maryland, due to its proximity to
the District of Columbia and the Commonwealth of Virginia. It would be
very difficult for a parent who lives in the District of Columbia,
works in Virginia, and possibly has a child attending school in
Maryland to understand why each jurisdiction has different policies on
social distancing measures such as school closings or tele-work
policies. The local governments in the National Capital Region are
meeting to find ways to coordinate school closing decisions so that
each government is informed of the decisions and justifications before
they are announced to the public.
2. addressing and meeting key medical requirements and resources
States and Localities Need Flexibility with the Use of Grant
Funding for H1N1.--As noted in the February 2009 GAO report on pandemic
influenza, the usual emergency management approaches to increasing
resource capacity during disasters, such as requesting assistance from
other States through the Emergency Management Assistance Compact
(EMAC), may not be viable options during a pandemic because other
States may want to hold onto resources in order to meet their own needs
or may not wish to expose their staff to the disease. EMAC still will
play a role in flu response but the amount of resources available from
other States will depend on the extent of cases and the severity of
illness in other States.
Workforce protection is an issue of key concern for States and
localities. While some funding for EMS protection is included in the
recent supplemental HHS Healthcare Preparedness Program grant, the
level is not sufficient to cover Personal Protective Equipment for all
EMS responders and does not offer any protection for law enforcement
and other public safety responders who may be at risk during a pandemic
in the line of duty. Public safety agencies have not been included in
these grants but will need to provide support to the health and medical
response. They will need the resources to protect their workforce and
also to ensure the ability to continue providing services with a
reduced workforce. Recent Congressional appropriations for pandemic
influenza only appear to provide funds to States and localities through
grant awards to public health departments and hospitals.
I ask that Congress and the administration introduce new funding
for PPE. In the absence of new funding, flexibility in the usage of
current grants would address these issues. Each State and locality will
have different needs that will not fit into ``a one size fits all''
box.
As for medical resources, Maryland knows it has gaps in surge
capacity that will require tough policy decisions this fall. The State
has insufficient knowledge of private antiviral inventories and needs
to encourage partnerships and communications with the private medical
sector. CDC has indicated it will assist States with a better
understanding of the commercial pipeline for critical pharmaceuticals
and medical supplies by developing a ``supply chain dashboard'' using
aggregated proprietary data from the manufacturers and distributors.
States look forward to access to such a dashboard to support resource
allocation and SNS decisions. While we cannot address everything this
fall, Maryland is in the process of developing forward-thinking
approaches to potential resource shortages through the use of
volunteers and by using health care workers in non-traditional roles to
assist with response. These efforts are described in detail below:
The Emergency System for Advance Registration of Volunteer Health
Professionals (ESAR-VHP).--ESAR-VHP is a Federal program that
establishes and implements guidelines and standards for registering,
credentialing, and deploying medical professionals in the event of a
large-scale national emergency. Maryland purchased a web-based, fully
compliant ESAR-VHP system in June 2009 from Collaborative Fusion, Inc.,
called CORES. After multiple phases of testing, it is anticipated that
the system will go ``live'' August 24, 2009 and will be available for
volunteers to register the following month. This system will allow
Maryland to register volunteers through a website, with volunteers able
to log into the system with a password at any time to update their
information. The CORES system will directly access State licensing and
National credentialing agencies to ensure volunteers are practicing
professionals in good standing. The system has a messaging and
notification component that will send messages through a variety of
methods (e-mail, pager, cell phone, etc). It also has a mission manager
component that will allow volunteers to view a detailed description of
missions as they arise.
Maryland Civic Guard.--Maryland's Civic Guard, launched July 16,
2009 by Governor O'Malley, is a coordinated effort between MEMA and the
University of Maryland's Center for Health and Homeland Security (CHHS)
that will engage local governments, private groups, businesses,
corporations, and nonprofit organizations to enhance the system of
cooperative volunteering during emergencies. The Civic Guard seeks to
build on the strength of current partnerships between local
governments, volunteer organizations, private businesses, and Maryland
State government. Under the first phase of the initiative, supported in
part by a FEMA Regional Catastrophic Preparedness Grant, MEMA and CHHS
will work with local government, the private sector, and non-profit
entities to identify resource needs and potential opportunities for
private sector and non-profit entities to create or expand
partnerships. The Civic Guard initiative will seek to share information
on needs and resources and, where possible, create agreements and
memoranda of understanding--before disaster strikes--with business and
non-profit partners.
Broadening scope of practice and use of non-traditional
professionals to assist with mass vaccination.--The State is developing
procedures that would have the Governor modify State regulations on a
temporary basis under a declared state of emergency to broaden scope of
practice standards among various trained health care providers and also
use trained health care providers in non-traditional roles to assist
with a mass vaccination this fall. Under this plan, the State would
consider using veterinarians, pharmacists, dentists, emergency medical
technicians, and other auxiliary providers to meet the personnel
requirements associated with a State-wide vaccination campaign.
3. evaluating and updating plans
Continuity of Operations Plans (COOP).--The recent H1N1 influenza
situation highlighted the need for up-to-date and comprehensive COOP
plans within State government to ensure the ability to maintain vital
operations and services for our citizens, especially in the face of
possible reduced workforce availability due to illness.
By request of the Governor, MEMA and DHMH are leading an initiative
to ensure that all executive agencies have viable, operational, and up-
to-date Pandemic COOP plans by September 1, 2009 and full COOP plans by
October 1, 2009. As part of this initiative, MEMA, in coordination with
DHMH, provided a series of free training sessions on developing a COOP
plan to State employees, locals, and non-profit agencies in July. In
addition, the Governor is requiring executive level personnel from all
State agencies and departments to participate in a 1-day COOP tabletop
exercise and is scheduling a State-wide COOP drill for late summer/
early fall. MEMA will begin a peer review process of all COOP plans
submitted October 1, 2009 or before.
Even with free training for local governments, it will be difficult
for some local agencies to complete or update their COOP plans because
of budget and staff shortages. The State is aware, but cannot currently
assist, in addressing known gaps in COOP planning within many private
businesses.
Coordinating Emergency Management and Public Health Planning.--On
July 27, Maryland initiated a meeting among each locality's public
health officers and emergency managers to share their experiences from
H1N1 and address communication gaps. This was an important first step
in bringing together two disciplines that, in the past, have not had a
great deal of experience working together and not always understood the
others roles and responsibilities. In the future, it will be critical
to have these disciplines integrate and coordinate their planning
efforts, especially for the myriad of issues in an influenza pandemic
that implicate both disciplines, such as mass fatality and special
needs populations planning. One way to assist with this task is to
ensure that public health and emergency management planning guidance at
all levels of government must be consistent. Unfortunately, the Federal
Government has created barriers to accomplishing this task because
public health planning guidance released by HHS is often inconsistent
with established emergency management planning guidance that is
released by FEMA. The States would like to see emergency planning
guidance come from DHS in coordination and conjunction with appropriate
subject matter experts, to ensure that all planning guidance provided
to the States is consistent.
CDC Pandemic Influenza Planning Guidance.--One area of public
health planning guidance in need of serious revision is the Centers for
Disease Control's (CDC) guidance to States on pandemic influenza
planning. In addition to being inconsistent with established emergency
management planning guidance, it does not sufficiently allow for
necessary flexibility or scalability to the specific needs of a State.
Maryland's pandemic influenza plan closely corresponds to the template
provided by the CDC, which ended up not being easily understood in an
operational context this past spring. DHMH is currently reviewing and
revising the State plan to address these issues in time for fall.
State Strategic National Stockpile Plan.--Maryland's SNS plan was
developed and exercised with the assumption that all of the available
resources would be deployed to the State, rather than the 25% that was
distributed in May. This demonstrates a flaw in the CDC's planning
requirements established for State plans. State SNS plans are rigidly
reviewed annually using a tool developed by the CDC. Under Federal
requirements, a State SNS plan is required to be written under the
assumption of receiving a 100% deployment of SNS assets. The CDC has
already recognized this gap and is actively working to develop the
scalable concept at the Federal level to provide to the States.
The Federal planning assumption was that a State's SNS shipment
would follow a request from the Governor, an assumption which proved to
be inaccurate in May 2009. Upon announcement that the State was to
receive 25% of its antiviral allocation, DHMH made arrangements for
receipt at the designated RSS site, and upon arrival, the shipment was
immediately inventoried by type, lot number, and expiration dates. A
long-term lease for secure, temperature-controlled storage was obtained
through an emergency procurement and the assets transported and
secured. Since then, the CDC and FDA have successfully worked out a
protocol for the extension of the shelf life of those antiviral
medications and soon-to-expire dates.
This effort to safely maximize the shelf life and therefore the
economic utility of these anti-virals should be replicated for the FDA
for other medication caches purchased by the States with Federal
funding.
4. improving early warning and detection of influenza
Maryland uses the Electronic Surveillance System for the Early
Notification of Community-based Epidemics (ESSENCE). This is a web-
based syndromic surveillance system designed for the early detection of
disease outbreaks, suspicious patterns of illness, and public health
emergencies. It automatically categorizes data such as chief complaints
from 46 acute care hospitals, over the counter medication sales from
two large pharmacy chains (approximately 300 total stores), and call
data from two State poison control centers into syndromes to detect
aberrations in the expected level of disease. ESSENCE runs automated
statistical algorithms on each syndrome and generates alerts when the
observed counts are higher than expected. To our knowledge, Maryland is
the only State with 100% connectivity to all acute hospitals,
reflecting achievement of a priority goal of Governor O'Malley.
DHMH epidemiologists review ESSENCE alerts daily and determine if
follow-up is necessary. Follow-up investigation of alerts includes
contacting local health departments and the hospital infection control
staff to obtain more information. In addition, DHMH epidemiologists
notify the DHMH Physician On-Call and State Epidemiologist for alerts
determined to have public health significance and initiate an active
investigation.
ESSENCE provides situational awareness on the health of Maryland
residents, detects disease clusters and exposures to allow for a more
rapid response to disease prevention and mitigation, and provides early
indication of increased influenza activity before cases are confirmed.
This analysis provides a critical tool for planning and resource
allocation. Maryland will continue sustained year-round flu
surveillance and is currently working with the State Superintendant of
Schools to assess what is needed to add school absenteeism data to the
system.
challenges in applying the stafford act to pandemic flu
Recent events, such as the 2009 Presidential Inauguration, have
demonstrated the need for Congress to review the Stafford Act
declaration process and regulations, particularly to ensure relevancy
to post-9/11 threats and emergencies. The Stafford Act was designed to
deal with disasters like tornados and hurricanes. The time has come for
Congress and the administration to revisit the Stafford Act,
particularly as it might apply to pandemic influenza and other public
health threats.
Under 42 U.S.C. 5121(b), the purpose of the Stafford Act is to
provide an orderly and continuing means of assistance by the Federal
Government to States and localities in carrying out their
responsibilities to alleviate the suffering and damage from disasters.
There are two major types of declarations:
1. Emergencies.--Any assistance for which, in the determination of
the President, Federal assistance is needed to supplement State
and local efforts and capabilities to save lives and to protect
property and public health and safety, or to lessen or avert
the threat of catastrophe in any part of the United States. 42
U.S.C. 5122(1)
2. Major Disasters.--Include any natural catastrophe, which in the
determination of the President cause damage of sufficient
severity and magnitude to warrant major disaster assistance
under the Act to supplement the efforts and available resources
of States, local governments, and disaster relief
organizations. 42 U.S.C. 5122(2)
There are two main types of assistance that correspond with these
declarations: Major disaster assistance and emergency declaration
assistance. Significantly less assistance is available under an
emergency declaration than under a major disaster declaration.
Expenditures made under an emergency declaration, unlike under a major
disaster declaration, are limited to $5 million per declaration, unless
the President determines that there is a continuing need for immediate
emergency assistance.
To qualify for Federal assistance, the Governor must:
(1) Certify that the situation or disaster is of such severity and
magnitude that effective response is beyond the capabilities of
the State and local governments;
(2) Direct execution of the State's emergency plan;
(3) Describe the State and local efforts and resources which have
been or will be used to alleviate the emergency;
(4) For emergencies, define the type and extent of Federal aid
required; and
(5) For major disasters, certify that State and local government
obligations and expenditures will comply will all applicable
cost-sharing requirements of the Act. See 42 U.S.C. 5170,
5191.
There are at least two challenges with applying the Stafford Act to
pandemic influenza. First, the Stafford Act requires that a State
describe the nature of the emergency or disaster and certify that it is
beyond the capacity of the State to respond. While this process is
relatively straightforward in the context of a storm or flood, it is
more difficult in a lengthy event of unknown duration without a well-
defined start and end date/time attached it, such as pandemic
influenza. FEMA has noted that a pandemic influenza will last longer
than other public health emergencies and may include waves of activity
separated by months. See FEMA Disaster Assistance Policy, DAP9523.17
(March 17, 2007). Unlike a request to rebuild a bridge, human service
needs are more difficult to quantify, especially with regard to a
State's capacity to handle the issue.
Given the unique characteristics of pandemic influenza, States need
specific guidance from the Federal Government on when this event would
be considered of such severity and magnitude that effective response is
beyond the capabilities of the State and local governments. In
addition, States need guidance on the level of specificity that would
be required in the declaration request with regard to available State
and local resources and the type and extent of Federal aid required.
Second, there is ambiguity in the law concerning whether the
Stafford Act would cover an influenza pandemic under a major disaster
declaration or just under a declaration of emergency. This legal
uncertainty has been noted in several recent congressional reports. See
e.g., CRS Report RL34724, Would an Influenza Pandemic Qualify as a
Major Disaster under the Stafford Act?, by Edward C. Liu, at 6-10 (Oct.
20, 2008.)
This ambiguity is significant for a number of reasons. Assistance
for declared emergencies is generally capped at $5 million while major
disaster assistance does not have this cap. A declaration of a major
disaster also expands the types of aid that are available to States,
localities, and individuals. For example, a major disaster declaration
permits the distribution of aid directly to individuals and households
to meet disaster-related medical and other expenses. 42 U.S.C. 5174.
States need guidance from the Federal Government on whether and
what type of major disaster assistance is potentially available for
responding to pandemic flu outbreaks and what thresholds would have to
be met for pandemic flu to be considered a major disaster, as opposed
to an emergency. Maryland is not the only State looking for this
advice. We are aware of the States of California and Oregon also
raising this issue.
Effective response to a pandemic flu requires a closely coordinated
effort among Federal, State, and local partners. Disaster assistance
should be clearly defined. States should not be left to guess and
debate what might or might not qualify for assistance. In light of
recent and emerging threats, it is time not only to provide guidance on
these issues, but to revisit the Stafford Act to make sure it is
relevant to 21st century threats and disasters.
conclusion
The State requests the following actions by the Federal Government
to help close gaps in preparedness and response for pandemic influenza:
1. We request guidance from FEMA on whether and what type of major
disaster assistance will potentially be available for
responding to pandemic influenza and what thresholds would have
to be met for pandemic influenza to be considered a major
disaster, as opposed to an emergency. We also ask that the
Stafford Act be revisited for its relevance and applicability
to post-9/11 threats and incidents like pandemic influenza.
2. We are concerned about leadership, coordination, and
communication at the Federal level. States need to understand
who is in charge at the Federal level and the difference in
roles and responsibilities between DHS/HHS. We need assurance
that all Federal agencies are using the incident command
system. We need to ensure we have timely, credible, definitive
guidance from HHS on issues such as school closings.
3. We ask for expansion and or flexibility on use of grant funds
for H1N1 and also ask that you consider providing funds to
other public safety disciplines outside of public health and
hospitals.
4. We ask that the Federal Government revise pandemic flu planning
guidance for the States and ensure that all public health
planning guidance is consistent with established emergency
management planning guidance.
Chairman Thompson. Thank you very much. We will have some
time for the explanation on the question.
We have 10 minutes left on this vote, and we have two 5-
minute witnesses.
Dr. Horton.
STATEMENT OF MARK B. HORTON, M.D., M.S.P.H., DIRECTOR,
CALIFORNIA DEPARTMENT OF PUBLIC HEALTH, AND STATE HEALTH
OFFICER
Dr. Horton. Thank you, Honorable Chairman Thompson and
Ranking Member King and other Members. It is a pleasure to be
here to speak and give a State health officer's perspective on
what has worked to date, what we have learned to date going
forward, and what are our major challenges.
As I begin, though, I wanted to reiterate points that have
been made about this virus. First of all, it is a novel virus,
and we don't have a vaccine. This means that there are huge
numbers of susceptible individuals still in our population. We
can fully expect a lot of sick people through the summer and
into the fall, a lot of hospitalizations and, yes, a lot of
deaths. We can, I think, fully expect that.
Second, this virus is acting very differently than seasonal
flu. The fact that we are seeing still growing activity in many
States right now today--we talk about a resurgence, but the
fact of the matter is, it with us right now and it is affecting
different populations; and it is mutable, which means we have
to maintain full capacity in our epidemiology in laboratories
in order to adequately monitor this and give us the information
to make the correct public health decisions.
What worked well: I want to congratulate the Centers for
Disease Control in taking the lead and ensuring that there was
good vertical collaboration and communication connecting the
State health officers with the local health officers throughout
the first wave of this pandemic. Some of the manifestations of
that were, for example, within days of the first identification
of the first cases in southern California, there were teams of
epidemiologists on the ground that included CDC
epidemiologists, State epidemiologists, and local
epidemiologists to ask the right questions to help us better
characterize the seriousness of the illness it was causing and
the transmissibility.
Second, laboratory capacity: Certainly, in California, the
coordination between the 24 local laboratories, the State
laboratory, and the California laboratories allowed us to test
fully 14,000 specimens within a period of 6 to 8 weeks--
unprecedented capacity--so it was good working together.
Similarly, with the Strategic National Stockpile, each
State received 25 percent of its allotment of antiviral
medications and masks. We were able to receive those and
redistribute those to 51 local jurisdictions in California
within a matter of days. We think this is a huge success and
speaks to the excellent planning and resources that have been
provided to us for putting things together.
What are the lessons that we have learned? First of all, as
I can congratulate the epidemiological and laboratory capacity,
I should also state that they were stretched to the limit. We--
no way could we have sustained the effort that we put forward
in the first weeks of this campaign. I am very concerned about
our ability to continue to monitor this pandemic adequately as
we move through the summer into the fall, into the regular
season.
Second, I think previous mention was made about the supply
chain for critical materials. We detected some serious
vulnerabilities there. Laboratories in the State of California
were telling me that we were within hours of having to stop
testing for influenza because we didn't have the proper
laboratory reagents. Similar problems were occurring about the
availability of antiviral medications and masks.
We need to rethink and reconfirm the consistency of the
manufacturers, the distributing systems to ensure that we can
continue to supply those materials to local and State health
departments that need them.
Third, we have inadequate data systems. Now, in the
epidemiology area, I think we have good systems in place to
gather epidemiological information at the local, State, and
Federal level, to be able to collate that data and tell us what
is going on.
We don't have similar effective data systems in the health
care system. At the local level, local health officers, and
emergency medical technicians can tell you what is available,
what is happening in their emergency rooms and in their
hospitals, but we have no way consistently to collate that
information regionally and at the State level so that I, as
State Health Officer, have a heck of a time telling my Governor
what is happening broadly in the health care system throughout
California.
What are our challenges moving forward? I think there are
three big ones, I think. The ones I will reiterate:
Maintaining epidemiological and laboratory capacity at the
State, local, and Federal level to be able to give us the
information we need on an on-going basis to make the right
public health decisions is of vital importance and is a major
challenge for us.
Mass vaccination, it has been mentioned before, but what I
want to emphasize in my comments is that I think we have the
capacity, if we decide to do this, to get the vaccine delivered
from the Federal Government to the State to the locals. The
real challenge is administering that vaccine to individuals.
That is going to be left up to the locals. The State and the
Federal Government and agencies need to be prepared to support
local agencies that are going to be responsible for actually
administering that vaccine.
Then one final comment is on surge capacity. There is no
question in my mind that our health care system is going to be
stretched to the limit if not overwhelmed. We need to take
major steps forward to assist the health care system in
preparing for this overwhelming increase in sick people that we
are likely to see later on this year, and I have further
details on how we can do that.
Thank you for the opportunity to testify.
Chairman Thompson. Thank you very much.
[The statement of Dr. Horton follows:]
Prepared Statement of Mark B. Horton
July 29, 2009
Good afternoon Chairman Thompson, Ranking Member King and
distinguished Members of the committee. I am Dr. Mark Horton, Director
of the California Department of Public Health (CDPH) and California's
State Health Officer. CDPH, in partnership with the Centers for Disease
Control (CDC), local health departments (LHDs), the California
Emergency Medical Services Authority (EMSA) \1\ and the California
Emergency Management Agency (CalEMA),\2\ responded to the recent
outbreak of a novel influenza virus (H1N1) which has resulted in over
3,200 reported cases of illness, 537 hospitalizations and 60 deaths in
California.
---------------------------------------------------------------------------
\1\ The California Emergency Medical Services Authority is
responsible to ensure quality patient care by administering an
effective, State-wide system of coordinated emergency medical care,
injury prevention, and disaster medical response.
\2\ In 2009 the California Office of Emergency Services and the
California Department of Homeland Security were combined in the
California Emergency Management Agency, CalEMA.
---------------------------------------------------------------------------
Thank you for asking me here today to discuss our response to this
outbreak, activities underway to address on-going illness, and our
continued preparations to respond to future pandemic influenza, most
urgently for the upcoming the influenza season. In my testimony I will
briefly outline our experience with the H1N1 outbreak this spring,
including lessons learned, but will focus on our activities to confront
the next pandemic influenza outbreak by highlighting:
Disease surveillance;
Public health interventions, including mass vaccination
campaigns;
Health care surge capacity;
Social disruption; and
Communications.
The California Department of Public Health operates more than 150
discrete programs \3\ ranging from communicable disease control, to
food, drug and radiation safety; drinking water management; hospital
and clinic inspections; chronic disease and injury control; maternal,
child and adolescent health; and, most pertinent to today's hearing,
public health emergency response. We employ more than 3,500 staff and
our current budget is approximately $3.7 billion to serve California's
38 million residents.
---------------------------------------------------------------------------
\3\ http://www.cdph.ca.gov.
---------------------------------------------------------------------------
introduction
California was the first State to identify the H1N1 virus. On April
17, 2009, the CDC, through laboratory data supplied by the Federal
Border Infectious Disease Surveillance (BIDs) program office located in
San Diego, determined that two California influenza cases had a unique
combination of gene segments not previously reported among swine or
human influenza viruses in the United States or elsewhere. Within days
CDC epidemiologists were on the ground in these counties to augment
local and State investigative resources.
By June 11, 2009, the World Health Organization categorized H1N1 as
Phase 6, indicating a global pandemic was underway. At that time, 74
countries on five continents reported more than 28,000 illnesses and
144 deaths due to H1N1. We continue to experience significant H1N1
activity worldwide and there is much that remains unknown about this
virus. Therefore, although our comprehensive public health surveillance
allowed California to be the first to recognize the circulation of
pandemic H1N1 and mount an aggressive response, we cannot relax our
vigilance.
background
The delivery of public health services in California, including
public health emergency response, is accomplished through a partnership
of Federal, State, and local agencies. In California local public
health departments have primary responsibility for responding to
outbreaks in their jurisdiction. In outbreaks involving multiple
jurisdictions, the State public health department, in conjunction with
CDC, and our State and local emergency management and homeland security
agencies, takes the lead to provide additional laboratory capacity,
confirmatory testing, coordinate distribution of stockpiled equipment
and supplies, develop State-wide policy guidance for public and private
agencies and assist with development and dissemination of public
information campaigns and provide resources when local needs exceed
available capacity. In California, public health follows incident
command system principles and county and State emergency management
agencies coordinate closely with public health during all responses. In
H1N1, CalEMA, in recognition that this is a public health emergency,
designated CDPH as the lead agency while serving as a close and
supportive partner.
Since 2002, the State of California has provided $470 million in
Federal grant funds to local health departments to build local health
department preparedness capacity for all-hazard and specific public
health emergencies. This funding included the fiscal year 2006
Congressional investment in State and local pandemic influenza
preparedness activities ($600 million allocated nationally).
Additionally, since 2004, California has invested more than $170
million in State funds to support activities to increase medical surge
capacity. These funds were used to purchase all available antivirals to
supplement the Federal investment in the Strategic National Stockpile.
California purchased three mobile field hospitals, alternate care site
caches, ventilators, respirators, and funded preparation of Standards
and Guidelines for clinics, long-term care facilities, and health
professionals.
Those resources were put to use when on April 21, in response to
growing numbers of cases of this pandemic H1N1, CDPH, and EMSA
activated the Joint Emergency Operations Center (JEOC), the State's
health operational center that coordinates and provides
multijurisdictional response support for our Federal, State, and local
partners. In addition, our 500,000-square-foot laboratory complex in
Richmond, California activated its emergency response function, the
Richmond Campus Coordinating Center (RCCC) to assist with
identification of cases which could be ``probable'' H1N1, which were
then sent to CDC for verification. Shortly thereafter, our Richmond
laboratories received equipment, training, and CDC certification to
conduct the confirmatory tests leading to a more rapid collection of
surveillance data. California was the first State in the Nation to
receive this certification for H1N1.
The JEOC and RCCC conducted numerous daily policy and operational
meetings/briefings that included congressional staff, our State
legislature, local health departments, sister agencies and departments,
and media (daily briefings for up to 200 media outlets). We established
a multi-lingual hotline available 7 days per week, and developed public
information materials (flyers, public service announcements, blogs,
Facebook, and Twitter outreach).
CDPH, through a State General Fund allocation, had already
purchased 3.7 million treatment courses of antivirals and CDC shipped
an additional 1.325 million courses of antivirals to California from
the Strategic National Stockpile for distribution to local communities.
During the course of this outbreak, CDPH received requests for
antivirals from 51 local health departments, 100 percent of which were
shipped within 24 hours. The California Highway Patrol provided 24-hour
security for the stored materials and escorts for all antiviral
shipments.
Governor Arnold Schwarzenegger declared a state of public health
emergency clearing the way for redirection of resources from other
departments, relief from administrative procedures, and pursuit of
Federal resources.
As we continue to monitor H1N1 activity our JEOC and RCCC remain at
a moderate level of activation. The State laboratory and the California
network of 26 local public health laboratories continue to test
hundreds of hospitalized and fatal cases each week; since the start of
the pandemic 4 months ago these labs have collectively tested over
14,500 specimens, compared to a typical volume of 2,000 in a regular
influenza season.
The data provided by this testing has enabled CDPH to have
continuous, timely, and reliable data on the pandemic and who is being
affected, allowing CDPH to better prepare for the 2009-10 respiratory
season and planning for antiviral and vaccination priority needs. Data
from the CDPH influenza surveillance has had a major impact Nation-
wide, including providing the first description of the clinical and
epidemiologic profile of hospitalized cases, identifying obesity as a
possible risk factor for death, and actively monitoring and providing
important data on the rare occurrence of antiviral resistant viruses
following the identification of the first U.S. case in San Francisco.
California led the way with the identification of this new virus
and with an aggressive multiagency response. We appreciate the Federal
investment which has taken place up to this point. Without it, our
capacity would have been significantly diminished.
lessons learned
Planning Assumptions.--As we prepare to respond to future
outbreaks, mindful not only of the experiences of the past few months,
but of more than 100 years of public health science and service to
inform us, we must stress that planning for pandemic illness, or any
emergency, requires certain assumptions which during an actual event
may be realized, or not. The test of those assumptions through the
course of an actual event becomes the basis for adjustments in the next
phase of planning. For example, as you may know, the planning models
assumed the initial outbreak of pandemic influenza would occur
somewhere within the Asian countries and would then take approximately
6 weeks to arrive in North America. H1N1 did not follow that model.
With the information available to us now, we believe it started in
North America, dramatically reducing the amount of time to organize the
response.
Decision-making Process.--Certain technical and operational
questions can be resolved relatively quickly and do not need to be
revisited, allowing attention and resources to be directed to emerging
or more complex issues. CalEMA and our California Department of
Forestry and Fire (CalFire) embedded incident response experts in our
State health operations center and laboratory operations center to
assist with application of incident command strategies. More extensive
use of the incident command structure will benefit future responses and
the CDPH is using experts from CalEMA to conduct incident command
structure training to strengthen the depth of that expertise within
CDPH.
Communications.--Because public health emergency response involves
a system of Federal, State, and local partners it is critical to ensure
that information flows efficiently among all parties. CDC and the
Federal Department of Homeland Security laid the groundwork for robust
and integrated interagency communications.
Yet it is critical to coordinate timing and frequency of
information exchange among relevant parties. The numerous daily
conference calls hosted by various Federal and State actors often
conflicted, forcing officials to choose between calls or redirect other
staff to participate in order to stay informed of new information.
Often the same officials who conduct the briefings are also the
officials who must be engaged in urgent policy decisions. Using
incident command strategies, California revised its briefing strategies
to avoid duplication and scheduling conflicts and smooth the timely
flow of relevant information to affected Federal, State, and local
officials.
Supply Chain.--We experienced an early and inexplicable collapse of
the private industry pipeline for antivirals and masks which, if not
resolved, would have rapidly depleted our stockpiles. The resolution
required Federal intervention as the suppliers were national companies.
Because the public sector relies so heavily on the private sector for a
range of goods and services, including the emergency response supplies,
Government will need to work more closely with the private sector to
ensure supply chain reliability.
Public Health Continuity of Operations.--Despite a compressed
timeline for response, the system responded appropriately and
effectively to the H1N1 outbreak. However, had the event been more
prolonged or more severe in its intensity, the public health systems,
most likely, and the health care delivery system, certainly, would have
been stretched to the limit. Our workforce of epidemiologists and
microbiologists were redirected from other disease investigations to
support the emergency response. If pandemic H1N1 becomes more severe or
if there is another pandemic outbreak, we could not sustain core public
health service levels, the continuity of our business operations would
be affected. As we look ahead to the start of seasonal influenza
activities we recognize the most optimistic scenario will find us
confronted with the demands of the seasonal influenza, with H1N1
response as an additional pressure on our public health and health care
delivery systems.
In order to support the State health and laboratory operations
centers' response to a more sustained or severe epidemic, California
has organized three additional response teams composed of staffs from
within and outside of the Department who are already receiving training
in the public health emergency response functions--everything from
epidemiologic emergency response to support functions such as
accounting and administrative support.
The new strategies must also take into account that the public
health workforce will also be stricken with influenza, resulting in a
high degree of absenteeism. In addition, we must commit to close
collaboration with the private sector to enhance their planning for
continuity of operations to ensure continued availability of essential
goods and services.
looking forward
CDPH and CalEMA have been working together to plan for further
escalation of the disease and the rollout of a vaccination campaign
this coming fall and winter. While CDPH focuses on some of the core
public health functions that must be in place, CalEMA is working with
CDPH on triggers for activation of the overall emergency response
structure, use of its business operations center to address resource
shortages in the supply chain and other issues.
H1N1 Surveillance/Monitoring and Laboratory.--Preparation for
surveillance to monitor for increasing pandemic activity, and possibly
increased morbidity and mortality, is under way. These active
surveillance activities include:
Continuing and expanding current surveillance components to
measure severity of the pandemic in different populations at
risk;
Laboratory testing to perform numerous activities including
detecting the emergence of new strains that may cause more
severe disease, identifying new strains that may be poorly
matched to the vaccine, and developing antiviral resistance;
and
Continuing to monitor for morbidity and mortality associated
with seasonal influenza.
Further, the emphasis on laboratory diagnosis is the key to strong
surveillance. Because H1N1 is a laboratory-based diagnosis, without
laboratory testing and results, there can be no H1N1 diagnosis. The
laboratory is the cornerstone of influenza diagnosis. As such,
laboratory monitoring of the pandemic and seasonal viruses in the
following populations will be the cornerstone of the surveillance
activities for the upcoming respiratory season:
Severely ill cases hospitalized in intensive care;
Fatal cases;
Sampling of hospitalized cases from Kaiser Permanente and
other academic and community hospitals State-wide;
Outbreaks in institutions, including hospitals, prisons,
schools, long-term care facilities; and
Outpatient specimens from over 150 volunteer sentinel
providers State-wide.
The CDPH Viral and Rickettsial Disease Laboratory (VRDL) is
prepared to test over 16,000 specimens in the upcoming respiratory
season to accomplish the above goals (the normal volume is a typical
season is 1,000 specimens). Approximately 15-20% of specimens will be
tested for antiviral resistance to continue to monitor for the
emergence of antiviral resistance. A subset of fatal and severely ill
cases will undergo genetic analysis to monitor for the emergence of new
strains that may not respond to a pandemic vaccine. Surveillance will
also monitor changes in the circulating seasonal influenza virus in
order to determine the formulation for the season influenza vaccine in
the subsequent 2010-11 season.
In addition, the laboratory surveillance data will be used so that
CDPH can monitor clinical and epidemiologic data associated with
severely ill and fatal cases and from outbreak settings for populations
at increased risk for morbidity and mortality. CPDH receives
surveillance data from many different sources, including electronic
hospitalization and outpatient data (Kaiser Permanente), influenza-like
illness (ILI) data from a group of sentinel providers who voluntarily
report ILA data to CDPH and from hospitals about severely ill cases
hospitalized in ICUs. The data will allow CDPH to provide guidance on
outbreak management, including in schools, and recommendations on
antiviral prophylaxis and treatment for hospitalized patients and
patients at high-risk, and vaccine prioritization strategies.
Public Health Interventions/Medical Countermeasures.--In planning
for the large task of providing pandemic influenza vaccine, it is
helpful to review the capacity to produce and deliver the seasonal
influenza vaccine. Influenza vaccine production has increased
dramatically over recent years, resulting in over 100 million doses of
licensed vaccine available in the United States every autumn.
Meanwhile, the public health system's capacity for vaccine
administration health has diminished since 1976, when it delivered 40
million doses of swine flu vaccine. As a result of increased vaccine
and decreased public infrastructure, public health departments provide
less than 10% of flu shots each year in California.
Just as in 1976, public health is needed in 2009-10 to coordinate
the delivery of pandemic influenza vaccine. However, instead of 40
million doses, the public health system is being asked to oversee the
administration of many times this amount, up to hundreds of millions of
doses of vaccine, with approximately one-eighth of this total going to
California.
While we are awaiting final information about the decision to
vaccinate and the amount and timing of vaccine production, California
is working quickly to:
Identify as many current private and public vaccinators who
can also administer pandemic vaccine;
Identify additional vaccinators who can fill in gaps in
services and map vaccinators to the prioritized populations
they serve;
Identify or build systems to distribute vaccine to
potentially thousands of vaccinators;
Establish or strengthen systems to share information with
vaccinators and receive and validate vaccine orders;
Track administration of vaccine; and
Monitor the safety of pandemic vaccines.
These vaccination program activities will require substantial
resources beyond what is already available. Public health will have to
allocate, distribute, and administer a two-dose vaccine for the entire
population in addition to the separate administration of the seasonal
influenza vaccine.
CDPH continues to work closely with LHDs, health care providers and
other State organizations such as the Board of Pharmacy to ensure that
mass vaccination campaigns and antiviral dispensing plans are able to
meet the needs of providing such medical countermeasures to all
affected persons in California. CDPH has developed an allocation and
distribution plan for shipping State and Federal stockpiles of
antivirals to local jurisdictions utilizing the Standardized Emergency
Management System. In addition, State-wide distribution plans for
vaccines is currently under development and we continually communicate
with local pandemic planning partners.
Surge Capacity\4\.--CDPH will continue to work with LHDs and health
care providers to ensure that California can respond to a surge in the
need for patient care.
---------------------------------------------------------------------------
\4\ Surge capacity is defined as a ``health care systems' ability
to rapidly expand beyond normal services to meet the increased demand
for qualified personnel, medical care, and public health in the event
of bioterrorism or other large-scale public health emergencies or
disasters''. (Addressing Surge Capacity in a Mass Casualty Event, AHRQ,
2004)
---------------------------------------------------------------------------
At the local level, LHDs, and health care facilities are building
partnerships and planning for patient distribution across the continuum
of care from home health to expansion of existing health care
facilities to Government-authorized alternate care sites to respond to
an otherwise overloaded health care system. LHDs have purchased
supplies to implement their plans and CDPH has stockpiled supplies and
equipment for 21,000 alternate care site beds.
CDPH has stockpiled 50.9 million N95 respirators and 2,400
ventilators (estimated to supply hospital works for 6 months) to ensure
the protection of health care workers. CDPH has allocated these on a
population based share and is packaging county allocations to enable
quick distribution.
CDPH has provided LHDs, hospitals, and other health care facilities
with standards and guidelines for emergency planning and operation of
alternate care sites, expansion of existing facilities, and tools to
move from individual to population-based care.
Social Disruption.--As Secretary Napolitano expressed many times
during the initial stages of the H1N1 outbreak, the potential for
social disruption during a pandemic is one of the most compelling
arguments for interagency communication and collaboration. As the
Director of Public Health and the State Health Officer one of my major
concerns is the lack of widespread emergency planning for continuity of
operations in the private sector and the potential for a disruption of
public and private sector goods and services. During the H1N1 response
we experienced a breakdown in the supply chain for antivirals. Without
adequate planning we can also experience collapse of the supply chains
for gasoline, food, and water. There must be a concerted and
coordinated effort between and among all levels of Government to
engender and support the necessary planning.
Communications.--As previously mentioned, under the leadership of
CDC and Homeland Security, the flow of information from the local to
the State to the Federal level and back again was nearly constant, even
at the initial stages of the outbreak. But we need to recognize that it
is communication with the public that will play a critical role in our
efforts to reduce the illnesses and deaths from pandemic influenza. As
history demonstrated during the 1918 influenza pandemic, communities in
which public officials made a commitment to sharing timely information
about self-protective measures reported a lower level of social
disruption from the flu. The public must be involved in our
preparedness efforts. They will need advice on non-pharmaceutical
interventions, such as staying home when sick. They will need advice on
the appropriate use of available health services otherwise the health
care delivery system will be quickly overwhelmed. These messages will
need to be repeated often and shared widely.
Public communication must be coordinated and emphasize the actions
that families, schools, and businesses must take to reduce the toll of
influenza. New tools, such as Web-based videos, text messaging,
Facebook, Twitter, and other social media will be employed. Community-
based organizations, faith-based organizations, and neighborhood groups
will be messengers, too, disseminating life-saving information. We must
motivate people to action without causing them alarm.
closing remarks
A mantra of emergency preparedness is that we are most ready for a
disaster right after we have experienced the last one and that is true
of our experience with the H1N1 outbreak this spring. But this type of
readiness can deteriorate quickly unless adequate resources are
provided to build and maintain the public health infrastructure.
There have been enormous efforts in California, the United States,
and globally to prepare for pandemic influenza. Congress has provided
significant support for these efforts, as have State and local
governments. Our detection of H1N1 came as a result of the investments
made in enhanced surveillance and laboratory capacity. Our ability to
maintain an effective response to this relatively mild pandemic also
came as a result of previous investments. A severe epidemic would
require mobilization of the public health work force for a period of
many months and has the potential to cause serious social disruption of
both public and private sector services.
I will return to my initial outline to suggest specific actions
which could strengthen our efforts to achieve readiness for pandemic
influenza:
Surveillance
Additional investment in the public health workforce
including epidemiologists, microbiologists, and laboratorians
to ensure enough scientists are on the ground to identity and
monitor the spread of disease;
Continued investment in epidemiologic and laboratory
physical capacity including expanding the network of sentinel
physicians;
Providing investment to enhance surveillance systems within
emergency rooms and hospitals to build capacity to monitor
prevalence of disease in real time; and
Investment in standardized electronic reporting systems and
centralized databases (such as automated laboratory information
management systems to connect hospital and private laboratory
data systems to local and State health departments).
Public Health Interventions
Investment in resources to ensure rapid development, re-
evaluation, and distribution of clear guidelines related to
social distancing strategies for schools and workplace;
Investment in supplies and guidelines for use of personal
protective equipment such as masks and the prophylactic use of
antivirals; and
Investment in supplies and distribution for mass
vaccinations.
Health Care Surge Capacity
Continue investment in the Strategic National Stockpile to
ensure adequate supplies antivirals, vaccines, and medical
supplies as well as the resources to distribute them;
Restore investment in medical surge capacity to prevent the
overload of the health care delivery system including
guidelines for patient triage, infection control in health
facilities, and vaccination of health care workers; and
Provide resources for an aggressive public information
campaign on the appropriate use of health care services.
Social Disruption
Dedicate Government resources to lead a multiagency
initiative to increase public and private sector development of
plans for continuity of operations and continuity of
Government. This is a critical undertaking in part because it
is the least developed segment of emergency preparedness and
the potential consequences could exacerbate any emergency
beyond all of our ability to respond.
Communications
Maintain the resources needed to support the flow of
information through the levels of Government and provide
resources for sharing among States. The excellent communication
spearheaded by CDC and the Department of Homeland Security was
well executed and adding the ability for communications across
State governments will further enhance information exchange;
and
Invest in development of traditional and new media materials
and messages for vaccinators, other medical providers, local,
State, and Federal health agencies and the public.
The H1N1 outbreak has demonstrated the unique and essential public
health skills and services that are provided for less than 1 percent of
health care expenditures. Let me repeat, less than 1 percent of each
dollar spent on health care goes to support the public health services
which would be required in an emergency response. Core public health
functions and the public health emergency response system deserve and
require our Nation's support.
The stronger the foundation of the public health system, the better
the system is able to respond. Continued Federal support of public
health infrastructure and emergency preparedness and response will be
vital to our ability to protect public health and safety when the next
pandemic influenza strikes.
Thank you for this opportunity to appear before you today. I am
pleased to answer any questions you may have.
Chairman Thompson. Dr. Farley, I think we are running out
of time. We have to go vote. We have about 20 minutes of votes
and we will come back to hear your presentation and Members
will ask questions.
The committee stands in recess.
[Recess.]
Ms. Clarke. [Presiding.] I now recognize Dr. Farley to
summarize his statement for 5 minutes.
STATEMENT OF THOMAS A. FARLEY, M.D., NEW YORK CITY DEPARTMENT
OF HEALTH AND MENTAL HYGIENE
Dr. Farley. I would like to thank the Chair, Congressman
Thompson, Ranking Member King and the committee for convening
this hearing.
Large, densely populated urban areas like New York City
face unique challenges when combating highly contagious viruses
such as influenza. The city has a population of over 8 million,
and the population grows to nearly 12 million on weekdays. More
than 1 million students attend about 1,500 public schools in
the city. These are ideal conditions for easy transmission of
influenza.
We know that we will not be able to prevent pandemic
influenza from entering New York City once it emerges anywhere
in the world; and that once it arrives, we can try to slow its
transmission, but will not be able to halt it. When H1N1
arrived in New York City in late April, we knew little about
how easily the virus might be transmitted, the severity of the
illness it might cause and who in New York City was at risk for
infection or severe illness. Through CDC we quickly acquired
the technology necessary to begin performing confirmatory tests
for the new H1N1 in our own laboratory, vastly improving our
ability to obtain timely information about the virus. The
development and distribution of such a test in such a short
period of time is a remarkable feat, and we appreciate the
support we received from our partners at the CDC.
From reports of severe illness, it appears that H1N1
community transmission in New York City was more widespread
than elsewhere in the United States. We estimate that at least
several hundred thousand and perhaps at many as 1 million
people in the city became ill with H1N1. With 47 recorded
deaths from H1N1, the case fatality ratio was approximately 1
per 10,000 cases, roughly the same as or lower than the case
fatality ratio for seasonal influenza.
During the outbreak, the Health Department recommended
closing 57 schools for 5 days to protect those at highest risk
of complications. School closures were not expected to
interrupt the spread of influenza in the city as a whole.
Our plans for the expected return of H1N1 in the fall or
winter are focused on assessment of current resources,
addressing gaps, and implementing enhancements. This process
will be greatly aided by the supplemental funding that Congress
recently approved, and we would like to express our thanks for
that support.
The best tool we have to prevent influenza infection and
severe disease is vaccination. We are hopeful that a vaccine
against H1N1 will be available before the virus returns. If
ample supplies are available, we will provide it to people in
ways that will protect those most at risk for severe infection.
However, because we do not yet know how much vaccine will
be available, we must prepare for a range of options. These
include vaccination by private medical providers, vaccination
in public clinics, mass vaccination in schools, and vaccination
using point-of-distribution, or POD, sites. If an H1N1 vaccine
is not available in ample supply before the virus returns, we
will have to rely more on antiviral medications to protect
persons at risk for severe disease. We are developing
contingency plans for use of antivirals that will rely on
distribution to hospitals and community health centers.
A significant challenge for public health departments will
be responding to an H1N1 outbreak while we are also promoting
vaccination against seasonal influenza. The overlap of these
activities will further strain private providers, health care
facilities, long-term care facilities and the health
department.
During the peak of the pandemic this past spring, some
hospital emergency departments were severely strained. Some
hospitals created additional space by setting up tents outside
of their emergency departments or used outpatient clinic space
to quickly separate influenza patients from others. To avoid
this overcrowding this coming season, we are working to develop
better ways to guide people's decision-making about when it is
necessary to seek medical assistance. We plan to publicize up-
to-date guidance on our website and disseminate it through
community and faith-based organizations, as well as schools.
To provide alternatives to hospital emergency departments,
the health department is working with community health centers
to expand their operations. We will also encourage hospitals to
develop specialized influenza clinics or alternate emergency
departments so they can handle patient load and reduce exposure
of influenza to other emergency room patients.
Our current thinking regarding school closure policy is
that if the virus does not increase in severity, we are
unlikely to recommend widespread or prolonged school closures.
Because the disease has been mild in nearly all children, such
closures would not stop the spread of the virus, and the
economic and social disruption caused by school closures is
substantial.
We will recommend that children and staff with symptoms
stay home and that children or staff at risk of severe disease
who come in contact with ill persons consult with their medical
provider about taking antiviral medications. On the other hand,
if there is evidence to suggest that the virus is more severe
or the disease incidence increases significantly, school
closures and other measures to reduce contact among large
numbers of persons may be considered.
To date, the cost of the H1N1 response for the health
department activities alone has been approximately $4 million.
City-wide costs are estimated to exceed $12 million. While the
funding has been very much appreciated, the funding that will
be needed to respond to a more severe return of this virus
would be substantially more.
I would like to thank, again, the committee for our
opportunity to testify; and I will be happy to answer any
questions you have.
[The statement of Dr. Farley follows:]
Prepared Statement of Thomas A. Farley
July 29, 2009
I want to thank Chairman Thompson, Ranking Member King, and the
other distinguished Members of the committee for convening this hearing
about the current status and future outlook of the national response to
pandemic influenza.
As you know, influenza is a serious viral disease. In New York
City, on average 1,000 people die of seasonal influenza each year, the
vast majority of whom are over the age of 65. Large densely-populated
urban areas like New York City face unique challenges when combating
highly contagious viruses such as influenza. The vast majority of New
York City commuters travel by public transportation--each day there are
between 7 and 8 million trips on the subway, and the population of the
city grows to nearly 12 million during the weekday. There are 1.2
million public school students attending about 1,500 public schools in
the city. These are ideal conditions for easy transmission of a virus
such as influenza.
The new strain of the influenza virus, H1N1, arrived in New York
City in late April, when a large number of students from a high school
became ill over a few days. At that time we knew little about how
easily the virus would be transmitted, the severity of the illness it
might cause, and who among the New York City population was most at
risk for infection or for severe illness.
Under the Citywide Incident Management System, the New York City
Department of Health and Mental Hygiene (DOHMH) is a lead agency in
responding to public health emergencies, including pandemics, along
with the Police and Fire Departments. In preparation for such an event,
the Department had developed a Pandemic Influenza Preparedness and
Response Plan. The plan is grounded in the reality that we will not be
able to prevent pandemic influenza from entering New York City once it
emerges anywhere in the world, and that once it arrives we can try to
slow its transmission, but will not be able to halt it. A key priority
in our plan, which is very relevant in our current response, is
minimizing severe illness and death by identifying and treating those
New Yorkers who are most at risk as early as possible in the pandemic.
In response to the initial H1N1 outbreak at the high school, the
Department activated its Incident Command System (ICS), drawing on all
needed agency resources and providing the highest level of coordinated
response during emergencies. Our response utilized the preparedness
infrastructure capacity and capabilities that DOHMH has been building
and enhancing since 2001, largely with the support of Federal funding.
The Department's preparedness infrastructure enabled the agency to
sustain an effective response over an 8-week period, with over 200
Health Department staff working on response activities at the height of
the outbreak.
The New York City Health Department constantly monitors influenza-
like illnesses (ILI) activity in community and health care settings
using a variety of surveillance methods. We routinely track hospital
emergency department visits, pharmacy sales of antiviral and other
medications, and influenza virus specimens taken from a network of
sentinel physicians, among other indicators, to monitor trends and
identify clusters of influenza-like illness.
Because H1N1 was a new virus and we had little information on its
clinical and epidemiologic characteristics, our priority for
surveillance was monitoring for more severe illness and death, which
required scaling up our efforts. In partnership with the health care
community and New York City's Chief Medical Examiner, we established
enhanced surveillance to track the number of persons who were
hospitalized or had died with influenza-like symptoms. We actively
worked with the health care providers reporting these suspect cases to
arrange testing for H1N1 in our laboratory.
The Department's Public Health Laboratory provides a wide range of
public health laboratory testing services. During the early period of
the outbreak, the Laboratory was able to determine that the ILI at this
high school was probably H1N1. We quickly acquired the technology
necessary from CDC and were able to begin performing confirmatory tests
for the new H1N1 by May 11. Our laboratory was one of the first
nationally to receive this test. Having this capacity locally improved
our ability to obtain timely information about the virus. The
development and distribution of such a test in such a short period of
time is a remarkable feat, and we appreciate the support we've received
from our partners at the CDC.
We observed some important patterns about this new H1N1 influenza
virus from our early investigations. First, the virus appeared to
spread rapidly among children. In contrast to seasonal influenza, the
elderly were generally spared. Second, nearly all of the younger people
who did become ill had mild symptoms, with most recovering completely
in 5-6 days.
The Health Department continued to survey New Yorkers to determine
what proportion of the city's population has experienced influenza-like
illness since late April, and what types of symptoms people have
experienced. The Health Department conducted two population-based
telephone surveys, asking about influenza-like illness from early May
through mid-June. These surveys were designed to be representative of
all New Yorkers, and from these data we estimate that at least several
hundred thousand and perhaps as many as 1 million people in the city
became ill from H1N1. With 47 recorded deaths from H1N1, the case-
fatality ratio is approximately one per 10,000 cases, which is roughly
the same as or lower than the case-fatality ratio for seasonal
influenza.
The H1N1 community transmission in New York City appears to have
been more widespread than elsewhere in the United States. As of July 1,
909 people diagnosed with H1N1 have been hospitalized in New York City.
An analysis of H1N1 hospitalization data found that the most common
risk factor for complications due to H1N1 in New York City thus far has
been asthma. We also observed that individuals who are younger than 2,
pregnant, or have a weakened immune system, diabetes or cardiovascular
disease were at elevated risk during the current outbreak
As with seasonal influenza, the H1N1 influenza has claimed lives,
47 so far in New York City since the outbreak began. While most of
these deaths have involved people with underlying risk factors for
influenza complications, some occurred in otherwise healthy people.
These deaths are tragic, but not unexpected. An important part of our
response is educating New Yorkers about why it is important for
individuals with these risk factors or chronic underlying health
problems to consult a health care provider when experiencing influenza-
like illness. We also urged all New Yorkers to take measures to protect
themselves from influenza, including avoiding close contact with people
who have influenza-like illness, and washing hands often with soap and
water.
During the outbreak, DOHMH recommended closing 57 schools for 5
days. The main goal of school closures was to protect those at highest
risk of complications from influenza by slowing transmission in that
particular school community and reducing exposures among those with
underlying conditions. School closures were not expected to interrupt
the spread of influenza in the city as a whole.
One of the greatest challenges facing the city during a pandemic is
to provide quick, clear, consistent, and frequent emergency information
to the public. Central to our communications strategy is the use of the
news media to keep New Yorkers well-informed about the progress of the
outbreak and about what measures they can take to protect themselves.
Information was made widely available through Mayor Bloomberg's
almost daily press briefings, and the Mayor's leadership in addressing
the issue routinely played a significant role in educating the public
about H1N1. The health department issued 25 press releases and held
eleven press conferences and briefings, generating thousands of media
stories. This method of communication is effective and efficient, and
allows us to reach the maximum number of people with the latest and
most up-to-date information.
The department also issued a wide variety of fact sheets,
brochures, posters, and pamphlets targeting various populations,
including the school community, employers, and faith and community
leaders. We translated these documents into 12 languages, and developed
low literacy materials. All of these materials were made available on a
dedicated page on the DOHMH website.
Equally important to our public communications is our ability to
distribute important clinical information to health care providers.
With approximately 29,000 subscribers, our Health Alert Network
provides an opportunity to get clinical recommendations and treatment
guidance directly into the hands of providers with the click of a
button; we sent out health alerts, as well as multiple clinical
guidance documents and treatment recommendations during the course of
the outbreak, providing physicians with the latest information on H1N1
activity in New York City. Our Provider Access Line, staffed by Health
Department and Medical Reserve Corp personnel, fielded nearly 5,000
requests for assistance. We also conducted numerous conference calls
with providers to review our guidance.
Importantly, regular teleconferences and communications with the
Centers for Disease Control provided invaluable assistance and guidance
to our efforts.
planning for recurrence of h1n1
We are now planning for the expected return of H1N1 in the fall or
winter, when influenza virus transmission traditionally peaks. We are
focusing on assessment of current resources, addressing gaps, and
implementing enhancements. DOHMH has established formal planning
workgroups, many of which have interagency participation, tasked with
implementing solutions to gaps and weaknesses identified. This process
will be greatly enhanced by the additional supplemental funding that
Congress recently approved and we would like to express our thanks for
that support.
surveillance & laboratory capacity
Perhaps the greatest challenge we face--one that is common to
pandemic planning and response--is the need to respond and make policy
decisions in the face of medical and scientific uncertainty. Influenza
can evolve in unpredictable ways; because we knew little about this
virus when it first emerged, our surveillance system was intensive and
relied heavily upon identifying and counting individual cases of
persons hospitalized for influenza. With the knowledge we have gained,
we expect to modify our surveillance approach in the fall to one that
is more sustainable and less resource-intensive. Since case-based
hospital surveillance will likely be impractical during the expected
upsurge in influenza-like illness, the approach entails an overall
assessment of the amount of influenza-like illness activity (for both
mild and severe disease), combined with laboratory testing from a
limited number of representative outpatient and hospital sites. Our
primary approach to track the overall trajectory of the potential
outbreak will be to monitor visits to hospital emergency departments
for influenza-like illness, through what is called ``syndromic
surveillance,'' and conduct periodic telephone surveys for symptoms of
influenza-like illnesses.
mass vaccination and antiviral distribution
The best tool we have to prevent influenza infection and severe
disease is vaccination. We are hopeful that a vaccine against H1N1 will
be available before the virus returns. If ample supplies of this
vaccine are available, we will provide it to people most likely to
develop severe illness from influenza, people who are likely to spread
the virus to those persons, and essential personnel who are likely to
come in contact with the virus such as health care workers. However,
because we do not yet know how much vaccine will be available, we must
prepare for a range of options, both regarding who will be vaccinated
and how vaccines will be administered. These include vaccination by
private medical providers, vaccination in public clinics, mass
vaccination clinics in schools, and vaccination using Point-of-
Distribution (POD) sites. We have conducted numerous POD trainings and
exercises for staff and volunteers over the last several years and have
identified 200 POD sites within walking distance of most city
residents.
If an H1N1 vaccine is not available in ample supplies before the
virus returns, we will have to rely more on antiviral medications to
protect persons at risk for severe disease. We are developing
contingency plans for use of antivirals that will rely on distribution
to hospitals as well as community health centers. We are aware that for
some populations, such as homebound and incarcerated persons, accessing
these sites will be difficult, so we are working on plans to address
the needs of vulnerable populations as well.
As part of on-going planning activities, we intend to define the
threshold for releasing stockpiled pandemic influenza response items
such as antivirals, personal protective equipment, and ventilators, and
develop guidance for organizations that would receive supplies from the
Strategic National Stockpile (SNS) and to refine plans for the delivery
of supplies to hospitals, long-term facilities, home-based care
agencies, and other outpatient providers.
A significant challenge for public health departments will be
responding to an H1N1 outbreak while we are also promoting vaccination
against seasonal influenza. The overlap of these activities will
further strain private providers, health care facilities, long-term
care facilities, and the Health Department.
health care surge capacity planning
DOHMH works closely with New York City's hospitals, outpatient
centers, congregate care facilities, and emergency medical service
agencies to handle a surge in persons seeking care for influenza. We
have developed medical surge protocols and built a local medical cache
of ventilators and personal protective equipment. DOHMH has also
conducted city-wide pandemic influenza exercises and drills with local,
State, and Federal partners, and hospitals and community health
centers. DOHMH has also engaged congregate care facilities and major
health agencies to provide guidance regarding care for patients at home
or other residential settings during a pandemic.
During the peak of the pandemic this past spring, some hospital
emergency departments were overwhelmed. Many emergency departments saw
a 200 percent increase in the number of patient visits. To deal with
overcrowding, some hospitals created additional space by setting up a
tent outside of their emergency departments or used outpatient clinic
space to allow those patients with influenza to be quickly separated
from others. In response to the demands placed on hospitals, DOHMH
provided clinical algorithms, screening, and isolation guidelines. We
also delivered personal protective equipment and pediatric Tamiflu
suspension to hospitals.
DOHMH recognizes the need to take action to avoid this overcrowding
in the future. We are working to develop better ways to guide people's
decision-making about when it is necessary to seek medical assistance.
To reduce visits to emergency departments by the ``worried well'', we
plan to publicize the availability of up-to-date guidance on our
website. The website will provide suggestions for people with mild
cases of influenza-like symptoms so that they can confidently care for
themselves at home. We plan to develop non-hospital sources of medical
advice for patients who need it. We are working on ways to disseminate
this information through community and faith-based organizations as
well as schools. To provide an alternative to hospital emergency
departments, DOHMH is also working with community health centers to
assure that they have the resources needed to expand operations during
resurgence of H1N1. DOHMH will also encourage hospitals to develop
specialized influenza clinics or alternate emergency departments to
treat patients with influenza-like illness so that they can handle the
patient load and reduce exposure to influenza in patients seen in
emergency departments for other reasons.
school closure policy
Under what conditions health officials should close schools to
limit the spread of H1N1 is a question that will come up again in the
fall. Our current thinking is that if the virus does not increase in
its severity from the spring, the New York City health department is
not likely to recommend widespread or prolonged school closures because
the disease has been mild in the nearly all children, because such
closures would not stop the spread of the virus, and because the
economic and social disruption caused by school closures is
substantial. We will recommend that children and staff with symptoms
stay home and that children or staff at risk for severe disease who
come in contact with ill persons consult with their medical provider
about taking antiviral medications. Individual schools may need to be
closed by school authorities if too many staff members are ill for the
school to administratively function. On the other hand, if there is
evidence to suggest that the virus is more severe or the disease
incidence is far greater than they were in the spring, school closures
and other measures to reduce contact among large numbers of persons may
be considered.
infection control
DOHMH continues to refine its guidance concerning infection control
in hospital, community, congregate, and high-risk settings, including
day care, universities, home visiting programs, and others. We are also
refining worker protection guidance for all public and occupational
groups, which will vary depending on the severity of the outbreak. On
July 23, 2009, CDC's Healthcare Infection Control Practices Advisory
Committee unanimously voted to recommend that surgical masks be worn by
health care workers caring for H1N1 patients, except when specific
medical procedures are performed, in which case N-95 masks are
recommended. DOHMH strongly endorses this infection control
recommendation.
incident response
The single most important way to build a strong preparedness
foundation is to build a strong workforce. DOHMH, with help from CDC's
Public Health Emergency Preparedness grant, supports staff positions
with preparedness and response expertise. In addition, DOHMH trains all
employees on the agency's Incident Command System. We have also
developed automated notification systems so that all agency staff can
be quickly mobilized to respond to any public health emergency. DOHMH
has also created the largest Medical Reserve Corps in the country, with
over 8,300 volunteers to call upon during an emergency response.
DOHMH also provides funding and expertise to key city partners to
purchase stockpiles of pandemic countermeasures and facilitate
development of pandemic influenza plans for city agencies and the
populations they serve, including the Department of Homeless Services,
the Human Services Administration, and the Department of Corrections,
as well as coordinating plans with the Office of the Chief Medical
Examiner.
communications and public outreach
To communicate accurately and rapidly to the public about
influenza, DOHMH is continuing to develop numerous templates for fact
sheets and press releases in many languages. These materials help us
provide well-considered information at very short notice to many
audiences. DOHMH also continues to focus on the importance of health
care provider awareness and education through regular communication and
through our Health Alert Network, as providers may be the first to
recognize unusual disease patterns that precede an outbreak.
To ensure timely communication with the public and the health care
community, DOHMH plans to enhance its existing protocols for rapid
development and clearance of public messages. CDC Public Health
Emergency Response funds will be used to further develop our ability to
communicate to New Yorkers in a variety of ways about H1N1. We will
also develop pandemic-specific public information and education
initiatives, including a range of community and workplace outreach
activities, especially to high-risk populations, and an advertisement
campaign. In addition, funds will be used for health care provider
education and training.
funding needs
To date, the cost of the H1N1 response for the city health
department activities alone has been approximately $4 million. City-
wide, costs are estimated to exceed $12.6 million. Core capacity
building at DOHMH to prepare for a fall recurrence of H1N1 are expected
to cost the Department more than $70 million, including laboratory
equipment, information technology support tools, occupational health
supplies and training, vaccine distribution, and procurement, storage,
and management of mechanical ventilators, and personal protective
equipment for health department and other key city personnel. City-
wide, the costs to fully prepare for a pandemic could exceed $160
million, including costs to the city's school system, the Medical
Examiner's Office, the Fire and Police Departments, and the city's
public hospital system. The cost of response if the H1N1 recurrence is
severe could be almost a half a billion dollars for all city agencies.
We are grateful for the additional funds recently provided by
Congress and those being allocated through the Public Health Emergency
Response Grants. The additional $7 million New York City expects to
receive for public health preparedness as well as $2.4 million for
hospital preparedness, will provide critical support as we continue to
build our core capacity and prepare for the influenza season and the
possibility that a more severe H1N1 virus will return. It is, however,
only a fraction of the real need.
While there are many factors involved in planning for an influenza
outbreak, the single most important resource is personnel. A well-
trained workforce is critical to the successful response to any
emergency. CDC's Public Health Emergency Preparedness grant, the
Hospital Emergency Preparedness Program funding and the Urban Area
Security Initiative funding have been extremely important to New York
City's preparedness. However, the steady erosion of funding in the last
few years hinders our ability to maintain progress and retain the
critical workforce needed to respond to the unique risks and public
health emergencies in New York City.
The primary source of support for the preparedness infrastructure
in New York City, the Public Health Emergency Preparedness Cooperative
Agreement through CDC, has steadily decreased since 2002 dropping
approximately 26 percent. In 2004, the Cities Readiness Initiative
program, initially provided to 21 high-risk cities, was created to
prepare major U.S. cities and metropolitan areas to dispense
antibiotics to their entire population within 24 hours. Recent formula
changes have resulted in a 25 percent reduction in New York City's
allocation, and we have been advised that we will receive another 25
percent reduction in the next grant year.
Although we appreciate the gap funding that is being provided
through recent supplemental appropriations, this is one-time funding
that cannot be used to close our personnel gaps--nor to replenish more
than $12.6 million in tax levy dollars we used for the recent H1N1
outbreak. In authorizing future funding mechanisms, we urge you to
consider the need for stable, predictable, and risk-based funding that
helps localities maintain their emergency preparedness infrastructure.
That is the key to real preparedness.
Thank you for the opportunity to testify. I will be happy to answer
any questions you may have.
Ms. Clarke. I thank all the witnesses for their testimony.
I remind Members that he or she will have 5 minutes to question
the panel. I will now recognize myself for questions.
I want to thank all of the witnesses for taking the time to
come and share your experiences in managing this outbreak. As
the only Member of this committee from New York City, I
especially want to welcome Commissioner Farley and thank him
for his diligence for managing this crisis in the city.
New York was hit hard with H1N1, with the highest death
count--63 total--of any State, and 43 deaths in New York City.
Confirmed cases in New York total 2,738 to date, and the
fourth-highest case count.
Commissioner Farley also testified that as of July 1, 909
people diagnosed with H1N1 have been hospitalized in New York
City alone.
Dr. Farley, tell us about the lessons learned by New York
City during the H1N1 outbreaks. Have you been able to rectify
the lack of guidance coming out regarding school closures,
managing H1N1 in other institutional settings and getting
information out to the public?
Dr. Farley. H1N1 ended up--while we had a pandemic
influenza preparedness plan, H1N1 was a little bit different
from what we had expected. It was a very widespread infection,
caused many, many cases, but it was milder than what we had
prepared for. So we had to adapt our pandemic preparedness
plan. That caused changes in policy about issues such as school
closures.
One of the lessons, I think, learned from this is that it
is important to have the ability to closely track the arrival
and the severity of a virus such as this and to be able to
change your plan according to the information you get. We were
fortunate to have funding for capacity, for surveillance, and
for laboratory testing, so we felt we had a very good handle on
where the virus was in the city, how severe the cases were.
We had to again adapt our response in light of that. That
adaptation at times involved us in giving guidance that was
somewhat in conflict with the guidance from the Centers for
Disease Control, so one of the lessons learned is that, at the
National level, plans need to be flexible for differences in
different areas and for differences in how severe the
infectious virus may be.
Ms. Clarke. Let me ask then, your concerns or your
challenges around institutional settings, the outbreak, for
instance--the Krome DRO facility in Miami, it is a temporary
immigration detention center, is just one example, for
instance, at the Federal level. We know there has been an
outbreak at Rikers Island jail.
Can you tell us about how the city handled the outbreak, as
well as the concerns of union and employees there?
Dr. Farley. We did have infections occurring in people who
were at Rikers Island jail. This is a jail in which many people
are arrested frequently, so there is a lot of communication
between the general city population and the jail.
We took very aggressive action to try to limit the spread
of the infection within the jail and, when necessary, provide
prophylactic medication to people who were at risk, who came in
contact with those with the infection. We were able to contain
the transmission in the jail, but it did point out to us the
fact that there are populations who can't follow general
guidance. They don't have an opportunity to not come in when
they are sick; they are forced to stay in that institution. So
we do have to have guidance for congregant settings like that.
But I think we did show that by taking proper precautions,
we were able to control the spread of that infection in that
institution.
Ms. Clarke. Aside from the recently issued CDC guidance,
what guidance have you given these facilities regarding their
operations, protecting both employees and detainees, and their
continued operation during a pandemic?
Dr. Farley. We provided specialized guidance to a variety
of different congregant settings, as well as jails, schools,
day care centers, each to a certain extent tailored to their
particular operations. That guidance did, to a certain extent,
differ from guidance from the Centers for Disease Control.
There was a period there when the infection was already
clearly very widespread in New York City, but the guidance from
the Centers for Disease Control was trying to essentially
contain it, and it was clearly past the containment stage. So
there were settings where, for example, we were not
recommending N95 masks because we felt that the virus was
similar to seasonal influenza and the droplet precautions were
adequate, and the virus was around and that CDC was still
recommending N95 masks. So our ability to adapt to the
situation, we thought was important, and we still believe it
was successful.
Ms. Clarke. Thank you very much.
I now recognize the Ranking Member of the full committee,
the gentleman from New York, Mr. King, for his questions at
this time.
Mr. King. Thank you, Ms. Clarke, and let me thank the
witnesses for their patience and forbearance today for putting
up with us and our schedule. I can speak for the Chairman; we
had no control over it, but I want to thank you for sticking
around.
I also want to join with Congresswoman Clarke in welcoming
Dr. Farley and thanking you for your service to the city. Let
me begin with a question to Dr. Farley, but also open up to
Director Muth and Dr. Horton.
I know that Congresswoman Clarke mentioned the fatalities
in New York. We had a high number compared to the rest of the
country, and I live right outside the city and many of my
constituents take the commuter lines into the city. But still,
for the most part, this was treated in the papers, after the
first few days in the media, as not being a big deal, as being
somewhat under control; and yet there was a 200 percent
increase in the emergency rooms.
Now, if this were a more severe strain of the virus, and
people were more ill than they were this past spring, do you
think that you can adapt to that surge both from those who are
genuinely sick and those, the ``worried well,'' who are seeing
reports in the papers of more fatalities or more serious
illnesses who will rush in.
I know when we--I have dealt with a number of New York
hospitals as far as if, God forbid, there is ever a dirty bomb
attack. Doctors tell me they are more concerned about the
people who are not sick, who would rush to the emergency room
even, than those who are actually affected by the act itself or
the attack itself.
Anyway, I would ask you and also Director Muth and Dr.
Horton whether or not you believe the hospitals are prepared
for that type of surge capacity.
Dr. Farley. As I said, the hospital emergency departments
were strained by large numbers of people coming there. Some of
those were the ``worried well.'' Some of those were people who
had symptoms of disease.
Mr. King. Those were symptoms that were not that bad? The
fact is, you said this was a very mild strain.
Dr. Farley. Yes. The vast majority of people got over this
fine, so it was not a very severe strain. Nevertheless there
were large numbers of people coming to the emergency
departments.
Our way of trying to handle that going forward is to,
first, communicate to people about the fact that if they are
well they do not need to come to the emergency department. Even
if they have mild symptoms, they don't necessarily need to come
to any medical provider; they might be able to do it over the
telephone. Also to provide alternate sites to get medical care,
such as community health centers; and also to work with
hospitals to handle people who will nonetheless have to come
there, again having potentially separate specialized flu
clinics or flu emergency departments.
I think, with that, the hospitals can handle this. I think
they will be strained, but I do think they can handle that. But
all of these pieces need to be put in place.
As a separate issue, if we have a more severe strain of--a
surge of people with very severe disease, the New York City
Health Department has done a lot to try to increase the number
of ventilators, so that patients who have severe enough disease
that they need to be on a ventilator can be handled.
Dr. Horton. The first point I would like to make is just, I
am very reluctant to continue to characterize this as a
``mild'' virus. We are saying that it is similar to seasonal
and----
Mr. King. As far as results, if there are a high number of
deaths there would have been more people rushing to the
emergency room. That was the point I was making.
Dr. Horton. I am making the point, with seasonal flu, even
with the fact that a good portion of the population is already
partially immune to the new virus and the fact that we have a
vaccine in place well before it hits, we still see 35- to
45,000 deaths and hundreds of thousands of hospitalizations.
Now, in this case, where there is a novel virus where
virtually nobody is immune to the virus and there was not a
vaccine in place early, I think we can anticipate problems.
A couple of other comments; I would just comment on what
Dr. Farley said, a couple of other steps.
I think there is some evidence, I could say as a doctor
myself, that physicians and nurses working in hospitals are not
consistently complying with recommendations about infection
control and personal protection. I think we need to get
everybody up to snuff and operating to ensure that the
hospitals and health facilities themselves not become a nidus
of infection in communities and that we are doing everything
that we can to protect health care workers so they can stay on
board. So I think that is extremely important.
Also individual hospitals, each one of them, should have a
surge plan, which means, when they activate it, they can
discharge patients that are ready to be sent home early and
they can restrict the admission of--new elective admission to
the hospital to ensure they maximize hospital capacity. So
there are a couple of additional steps I think they can take to
help the health system absorb some of this additional activity.
Mr. King. Director Muth.
Mr. Muth. Congressman, I spent 30 years at the local level
riding medic units and everything, and I would say our system
is strained every day, especially the ERs.
So our concern certainly would be that the extra pressure
that a pandemic would put onto that system I think would be
very tough to handle, although I do think one of the ways of
handling that certainly is through the public education effort.
I think we need to do a push to educate the public at all
levels across the country with the same message, which I think
is critical. To follow what Dr. Horton said, that if they are
not--letting them know if they are not ill, then they don't
necessarily need to go to a hospital or to a private physician.
Many in our population depend on a hospital for their
primary care. So you are going to have that compounding the
situation.
Mr. King. Just to ask one question on the record; I don't
expect a answer, just for the record.
Vice President Biden took a lot of heat when he made the
remark about travel on the Metro, but in densely populated
areas such as New York, Chicago, Boston, San Francisco, where
so many people do go on subways and commuter lines, if this did
become a more severe strain, would the city of New York look
into whether or not we would cut back or encourage people not
to take the subway lines?
Dr. Farley. We did look into the issue of mass transit in
New York City. The vast majority of people in New York City
rely on mass transit, and the feeling was, we could not shut
down the mass transit system because then people couldn't go to
work including health care workers and other essential
personnel.
There are things we can do to reduce the number of people
on mass transit and encourage people other ways to get around.
But the fact is in a densely populated city like New York, more
people are going to come in contact with each other in many
locations; and so you will likely have more spread of a virus
like this.
Mr. King. Thank you very much.
Thank you, Madam Chairwoman.
Ms. Clarke. Ms. Richardson, I understand it is your turn to
ask your questions.
Ms. Richardson. Thank you, Madam Chairwoman, and Ranking
Member for having this very much-needed hearing.
I would like to speak to the employees, the Federal
employees aspect, and I had an opportunity to read your
testimony and congratulations to all of you who hung in here
through all of these votes we have.
Is anyone still here from DHS? Okay.
HHS? Okay, great.
In your testimony, you said that folks were not receiving
consistent and timely information and not adequate resources
and differences from a Texas airport and various airports of
what the procedure was.
Do you feel better empowered today with the folks to be
able to respond? Have you seen any difference since when that
occurred to where we are right now?
Ms. Kelley. I think in TSA, in particular, there is a
recognition that they had serious communication issues with not
getting the message out to employees.
We had a meeting as recently as yesterday with TSA about
communication, and so I think there is a much clearer
recognition, hopefully; and we have offered to work with them
to help figure it out so it does not happen again.
In CBP, in Customs and Border Protection, this MOU that was
just signed this morning was really the issue. In my view, that
was much less a communication issue than their not being
willing to put out a very clear message that employees had the
choice to wear a mask, if they felt that it was important to
them and they thought it was important to their families.
Ms. Richardson. So as far as the Customs folks, they are
now aware of--as of today, it is their choice to wear a mask?
Ms. Kelley. As of today, because of the MOU that NTEU
negotiated, it will be clear to them and NTEU will communicate
that message to every employee we represent there to make sure
they have the information, yes.
Ms. Richardson. Has TSA, to this point--the employees--
received a blanket communication that that is their option as
well?
Ms. Kelley. My understanding is, the communication we have
was issued May 29, but it only got as far as the heads of each
of the airports, that it did not seem to get into the hands of
the TSOs. I believe--following yesterday's meeting, I know
actually, as of about 10 days ago, it started making its way to
the front lines; and I believe, following our meeting
yesterday, that that will be clarified for all employees.
Ms. Richardson. Could you please advise this committee
within the next 2 weeks if for some reason that communication
does not get out to all of you?
Ms. Kelley. I would be glad to do that.
Ms. Richardson. Thank you very much.
I yield back the balance of my time.
Ms. Clarke. I now recognize the gentlelady from Texas, Ms.
Jackson Lee, for 5 minutes.
Ms. Jackson Lee. Thank you. I appreciate Ms. Richardson and
her line of questioning, and I thank you for allowing me to
question as well. I am glad that she acknowledged that
individuals are here from DHS and from Health and Human
Services.
Madam Chairwoman, I was delayed because of the earlier
panel because I was in back-to-back meetings on negotiating
health care reform in one meeting dealing specifically with the
global issue of what we were addressing and a second one that
was Texas-based. So I am going to make some comments and ask
some questions that sort of generate back to the first panel.
But I do want to place on the record that Texas also had a
very high impact; and the number of counties include, for H1N1,
Baylor County, Brazoria County, Cameron, Collin, Comal, Dallas,
Denton, El Paso, Guadalupe, Hidalgo, Harris, Johnson,
Montgomery, Fort Bend, Grimes, Matagorda, Tarrant, Travis,
Nueces, Starr, and Upshur Counties. Texas is a huge State with
a lot of counties.
I think, Ms. Kelley, you were focusing on the concern that
I had, along with the State commissioners, and I am very glad
Secretaries Lute and Corr have indicated they will now have
regional strategies. I hope they call them regional teams.
Obviously, that doesn't go directly to Federal employees.
But, let me ask you, Ms. Kelley, do you think an ounce of
prevention is worth a pound of cure?
Ms. Kelley. I do, and I think especially when it comes to
front-line employees who are facing these very real threats of
running into travelers who may be carrying any kind of a virus,
that they have the right to make that choice on their own.
Ms. Jackson Lee. I remember the debate of TSA, in
particular, and TSOs asking for masks, and I remember the
confusion of not being able to get an answer; is that correct?
Ms. Kelley. In TSA, that was correct. In Customs and Border
Protection, they were told no, they were not allowed to wear
the mask.
Ms. Jackson Lee. So in addition to confusion, it was also
an answer that was a rejection. With the MOU, do you feel that
there is a greater stakeholder position right now, we don't
know how it is going to turn out, but we do know you have a
stakeholder position; is that important?
Ms. Kelley. It is very important, and I believe that the
language is very clear that employees now have that right. As
you say, implementation will be the real test.
Do you also think, and I really respect scientists because
they are dispassionate. They look at things as 1, 2, 3. But
isn't it important or do you feel it is important because most
of us are laymen and not scientists, that we have the right
amount of passion and concern and also quick acting so that
there brings a sense of calmness, whether it is a Federal
employee or the broader community?
Ms. Kelley. Absolutely. The more information the better,
and in English that employees can understand; not in scientific
or medical language which often causes even more confusion. So
the clearer, the more direct, the better.
Ms. Jackson Lee. Thank you very much. Let me ask the two
commissioners from California and New York and certainly
Maryland, Texas, unique, not represented here on the panel, but
a lot of different counties, enormously diverse, as some of
your States are as well. My concern is that the CDC and others
who were engaged did act dispassionately as scientists. I
believe that is very important. But do you believe it is
important for there to be quick-acting communication with State
agencies, and do you believe that these regional sites which
may be over a certain number of States would also be important
to come to large cities like New York, large cities like Los
Angeles, large cities like Baltimore, and large cities like
Houston, that there is an on-site team in these larger cities?
The commissioner from New York.
Dr. Farley. Our communication in this outbreak was mainly
through Centers for Disease Control on health issues. There are
larger issues there, and if this outbreak was more severe and
if it impacted on critical infrastructure, we would need to
have discussions with agencies outside of health agencies in
having a regional coordination, a regional presence, would be
valuable.
Ms. Jackson Lee. You wouldn't object, however, if you had
localized coordination, meaning some of these officials on-site
in New York City?
Dr. Farley. That would be valuable in New York City, yes.
Ms. Jackson Lee. The gentleman from California.
Mr. Horton. I certainly agree. I think that representation
would be helpful. I think in the case of what we have seen so
far, there was very good vertical integration of messaging. But
recognizing the fact that both across the United States and
within States there is a lot of regional differences, to the
extent that the whole process of communication can be
regionalized, that may bring additional helpful information to
myself, for example, as a State health officer, to know what is
happening and the differences between different regions within
the State and perhaps within the country.
Ms. Jackson Lee. A particular team that might be dispatched
to an L.A. or a San Francisco, would also be helpful? A team
dispatched to a large city would also be helpful?
Mr. Horton. An epidemiology team, yes. For example, at the
very beginning of the outbreak in southern California, as I
mentioned in my comments, the Centers for Disease Control
provided epidemiologists on-site that were matched with
epidemiologists from the State and that worked locally in
southern California to assess. That was a very effective way of
getting early information about the outbreak itself, how severe
it was, and how transmissible it was. I think that is a very
valid approach.
Ms. Jackson Lee. Thank you. Madam Chairwoman, if I can
conclude, I do just want to say this: The most vulnerable were
our large school districts, and I would like to place on the
record for DHS and HHS that there needs to be some focusing on
school districts, and I would ask for a team such as the ones
the commissioner has mentioned to not only be on the cities,
but that they should be teamed up with school districts because
that is where our impact was, that is where parents were
panicking, and that is where we had no answers. I know it well,
having a number of those schools in my congressional district.
I thank this second panel, and I look forward to meeting with
HHS and DHS on this issue going forward.
Thank you.
Ms. Clarke [presiding]. I have a second round of questions.
I don't know if the gentlelady from Texas does.
I am very mindful of everyone's time at this stage, but
there are a couple of outstanding issues that I want to have on
the record, and that has to do with the drug resistance issue.
I want to raise this with both Dr. Horton and Dr. Farley.
By January 2009, our committee found that the
pharmaceutical interventions for pandemic influenza would be
limited. This turned out to be the case with novel H1N1. There
was and is no readily available vaccine, and this particular
strain of H1N1 was already resistant to two of the four
antivirals ordinarily useful in combating influenza. How are
you overcoming this problem to deal with the H1N1 now? How do
you think this problem needs to be addressed in the future, and
what do you need from Congress to make this happen?
Mr. Horton. I will be the first to speak from California.
First of all, the information I have is that currently the
information we have about the H1N1 virus is that it is almost
universally sensitive to the two most commonly used and
stockpiled antiviral medications that are available to us.
The stockpile that was set up under the direction of the
Federal Government, and most States bought their purchases,
oseltamivir or Tamiflu, and Relenza. To my knowledge, to date,
there have been only a handful of cases of H1N1 that have been
resistant to those drugs.
So I think we are very encouraged at least at this point.
To my knowledge, the information we have so far from the
southern hemisphere is that the genetic composition and the
phenotypic expression of the virus has not changed. So I am
feeling that despite the fact that there is some resistance to
other organisms, to date anyway, we are feeling good that we
have the antivirals on hand to combat the problem.
Dr. Farley. I agree that the antivirals we have now are
effective against the virus. However, the virus can develop the
ability to become resistant to the antivirals we are using now.
In which case then, if we didn't have a vaccine, we would have
no tools.
So I do think there is value to developing additional
antivirals to keep one step ahead of the influenza virus.
Mr. Horton. I would agree with that.
Ms. Clarke. I yield 5 minutes to Congresswoman Jackson Lee.
Ms. Jackson Lee. Thank you very much. I ended on the note
dealing with school districts, and I would appreciate it if the
three health directors would comment on the uniqueness of
schools and school districts as it relates to health
intelligence, getting to you as State leaders and then it
transmitting to the consumer. I hate to call a student a
consumer of H1N1, that is not the interpretation I want given,
but the impacted individual. It seems in our State, certainly
children were the most vulnerable. Schools were an immediate
source, and I would also want to put on the record that we have
noted that a few summer camps have also been, in essence,
victimized by H1N1. May I start here, please.
Dr. Farley. This particular strain of influenza, H1N1,
particularly favored younger people. There was transmission
among younger people. There may very well have been
transmission among schools. That makes them important sites for
us to consider how to prevent infection with the next epidemic
wave.
I understand today there are recommendations that children
are a high priority group for vaccination when the vaccine
becomes available. It is important for us to vaccinate children
to try to prevent infection in the fall.
Ms. Jackson Lee. Mr. Horton.
Mr. Horton. How I would like to address your question and
concern is just to point out what really is needed is cross
sectorial collaboration on a much stronger level. I think what
we experienced early this spring when the CDC came out with
recommendations with regard to school closures was a few
hiccups, to say the least.
I would like to think vertical integration allowed us to
respond to that, and CDC modified it in a very timely fashion.
But nonetheless, I think public health needs to be more aware
of the implications of public health recommendations, like
school closures.
I mean, how is education going to continue? How are
nutrition programs going to continue? What is going to be the
impact on the parents and their workplaces if we send kids home
from schools? All of those factors, we need public health to
put the science forward in terms of the effectiveness of
closing a school, but we also have to factor in the social
impacts of that and make sure that we have everybody on the
same page, that we have communicated effectively with the
school authorities to ensure that we all agree that this is the
right step, we are aware of the implications, and we have a
consistent communication to the parents and the children.
Ms. Jackson Lee. I think that is what was missing.
Mr. Muth.
Mr. Muth. Madame, I am from an emergency management field,
not the medical field.
I would like to say, getting back to the whole topic of
communications, within Maryland, we certainly have the problem
with the National Capital Region in that it is very likely that
we would have a person living in Maryland, possibly dropping a
child off in the District of Columbia for school, and either
living or working in VA. Because of that tri-State or the two
States and the District of Columbia, it is really critical that
we are all issuing the same guidance and direction. That
certainly was a stumbling block for us in the spring event.
Also, because the CDC, and I am not blaming or putting
fault on them, but constantly changing the guidance for closing
schools also created confusion in those areas. So I think we
have a ways to go to ensure that the communication is across
the board and going back to your idea of regional teams, I
think that is a great idea. Part of it should be the whole
communication package should go along with that.
Ms. Jackson Lee. We don't want communication to be missing,
and we don't want to dumb down the communication, in essence,
to suggest that people should not be concerned.
Mr. Muth. No. Absolutely not. I think the facts should come
out as the facts are.
Ms. Jackson Lee. Ms. Kelley, Federal employees are
everywhere, and many times dealing with the public. Do you
think it is crucial that, beyond the MOU you have, there be an
immediate contact communication with our Federal employees and
their leadership when there is a sign of a pandemic of the kind
that H1N1 could have been?
Ms. Kelley. I do.
Ms. Jackson Lee. I thank you very much. I yield back.
Ms. Clarke. I thank the witnesses for their valuable
testimony and the Members for their questions.
Before concluding, I would like to remind our second panel
of witnesses that the Members of the committee may have
additional questions for you, and we will ask you to respond
expeditiously in writing to those questions.
Hearing no further business, the committee stands
adjourned.
[Whereupon, at 5:51 p.m., the committee was adjourned.]
A P P E N D I X
----------
Questions From Chairman Bennie G. Thompson of Mississippi for Ms. Jane
Holl Lute, Deputy Secretary, Department of Homeland Security
Question 1. During the hearing, various Members asked you about
lessons learned from responding to the H1N1 outbreaks/pandemic. How is
the Department of Homeland Security identifying lessons learned from
its preparedness for, detection of, and response to the H1N1 outbreaks
and pandemic influenza? Is this information being added to the DHS
Lessons Learned Information Sharing (LLIS) system? If not, why not?
Answer. The Department of Homeland Security (DHS) has identified
lessons learned from the response to the spring outbreak of H1N1, and
has in fact implemented changes to improve our response for the fall
wave. Specifically, while DHS found that the United States Government
(USG) pandemic planning began in 2005 was of great value in responding
to the H1N1 outbreak, DHS learned that much of what actually occurred
in the spring was not contemplated by prior planning. First, contrary
to planning scenarios, based upon the H1N1 spring outbreak, DHS learned
that an initial outbreak with high mortality rate in one country does
not necessarily mean that the same pattern will follow in the United
States. In fact, the H1N1 spring outbreak in the United States proved
to have a relatively mild or low mortality rate and relatively few
hospitalizations. DHS also learned that contrary to our planning
scenarios where outbreaks usually start overseas in Africa or Southeast
Asia, a pandemic can start with little or no warning closer if not at
home, here in the Americas. Fortunately, the USG was able to use the
information developed over the years to adjust plans for community
mitigation, for determining science-based border strategies, for
vaccine prioritization, for pre-deploying antiviral medications quickly
to States and for rapidly creating messages that helped the public
understand what the Nation was facing. Also, very importantly, over the
years, DHS developed close working relationships with interagency
partners, which facilitated coordinated response and communications.
DHS was always planning for the ``worst-case scenario'' which is
appropriate, but not enough attention was paid to adapting our policies
and plans for a mild to moderate pandemic. Since the spring, the USG
has been working on focusing our preparations on the current pandemic
scenario. DHS found that, while the Department did an excellent job
stockpiling personal protective equipment and antivirals for the DHS
workforce, the Department must continue to review and update the
policies that address workforce protection, communications, and
training of employees.
These lessons learned became a major component of the Federal
Action Matrix that is currently used to track and monitor aspects of
the USG preparation and response to H1N1. Action items were developed
for improvement in the following areas: DHS incident response
coordination, DHS external communications, workforce protection and
guidance, support of the Secretary as the Principal Federal Official,
and in incident preparedness and continuity of operations. Coupled with
the development of a four-pillared approach to preparedness, response,
and recovery, the USG is in a much better position to deal with a
future pandemic as a result of this after-action work.
LLIS currently contains pandemic influenza lessons learned. DHS
intends to include updated information on lessons learned from the
current H1N1 response on LLIS.
Question 2. FEMA Disaster Assistance Policy 9523.17 mentions the
Federal Coordinating Official (FCO) for an influenza pandemic. Who is
the FCO for the H1N1 pandemic?
Answer. There are pre-designated H1N1 team leaders and teams for
each State and U.S. Territory. If a declaration is warranted and
declared, the President would appoint an FCO for the declared State or
territory to execute any appropriate Stafford Act programs. At this
time, the plan is not for a single FCO for H1N1.
Question 3. In your testimony, you made reference to finalizing
operational plans to ensure that DHS essential functions are maintained
and personnel are protected during a sustained outbreak. Please forward
these operational plans, the DHS strategic plan for pandemic influenza,
and H1N1 and pandemic plans created by the DHS components and major
offices to the committee.
Answer. The Department of Homeland Security, in coordination with
Federal, State, local, Tribal, private sector, and non-governmental
organizational (NGO) partners, continues to develop and execute
pandemic influenza-related planning activities. Ensuring that all
essential functions are maintained and protected during a sustained
outbreak has been an integral component in all pandemic planning and
operations. The second implementation plan is the DHS 2009-H1N1
Influenza Implementation Plan, which has been signed by Secretary
Napolitano and is provided to the committee as requested as an
attachment to this document.
The DHS 2009-H1N1 Influenza Implementation Plan identifies specific
component roles and responsibilities, and it also directs all DHS
components to develop plans that address key preparation and response
actions, performance of mission essential functions, workforce
protection, continuity of operations, and communications with key
stakeholders during the H1N1 influenza pandemic. For example, FEMA
developed a Pandemic Influenza Plan (April 19, 2009) that focuses on
FEMA's responsibilities to maintain essential functions and services,
ensure the safety of its employees, coordinate Federal response and
support interagency activities, and communicate with internal and
external stakeholders. FEMA is also developing a FEMA H1N1 Plan to
include guidance for workforce protection, mission sustainment, special
considerations for response in an H1N1 environment, and support to
other Federal agencies.
Question 4. When will the DHS strategic plan for pandemic influenza
be posted on Flu.gov?
Answer. The DHS strategic plan for pandemic influenza is the DHS
2009-H1N1 Influenza Implementation Plan, which has been signed by
Secretary Napolitano. This document establishes an integrated strategy
for H1N1 preparedness and response based on the Framework's four
pillars as described in our response to question No. 6. The DHS plan is
also ``For Official Use Only'', and it will not be posted to the
website.
Question 5. Please describe the ``active engagement'' of DHS with
its tribal partners.
Answer. The Department of Homeland Security (DHS) via the Office of
Intergovernmental Programs engaged in outreach during the Spring H1N1
outbreak and has on-going engagement with the tribal community in
preparation for the upcoming H1N1 flu season. Working with the
Department of Health and Human Services (HHS) and in particular, Indian
Health Services (IHS) who has the lead, DHS coordinates directly with
tribes, through national and regional tribal associations, and with the
Bureau of Indian Affairs to provide guidance on H1N1 readiness efforts
for individuals, communities, businesses, and schools. DHS is working
with several HHS components--the Indian Health Service (IHS), Centers
for Disease Control and Prevention (CDC), and the Office of the
Assistant Secretary for Preparedness and Response (ASPR)--to ensure
that we are communicating and coordinating our outreach to Tribes. DHS
Intergovernmental Programs (IGP) send regular e-mail communications to
Tribal leaders and Tribal organizations as new materials related to
H1N1 issues are developed. DHS has engaged and is looking to engage
with its other Federal partners at four of the largest Tribal
stakeholder organizations at their annual conferences over the next 2
months concerning the latest information on H1N1, the Conferences are:
a. September 9-11, 2009: National Native American Law Enforcement
Association Annual Conference, Tulsa, OK;
b. September 14-16, 2009: National Indian Health Board Annual
Consumer Conference, Washington, DC;
c. October 11-16, 2009: National Congress of American Indians
Convention, Palm Springs, CA;
d. October 22-25, 2009: National Indian Education Association
Conference, Milwaukee, WI.
Question 6. In your testimony, you stated that, ``we will be
prepared and we will be ready'' for the pandemic this fall. Please
provide a timeline detailing activities that will be undertaken to
reach a full state of readiness.
Answer. To achieve a full state of readiness, the Federal
Government, through its various Departments and agencies, and the White
House National Security Staff (NSS) are leading the effort to meet the
preparedness and response challenges that the H1N1 virus presents to
the Nation. Together, we are achieving substantive progress toward
meeting the goals set by the White House. Our ``whole of government''
approach to addressing these challenges compels Federal Departments and
agencies to work collaboratively and under exceptionally tight
timelines.
On August 5, 2009, the NSS published the National Framework for
2009-H1N1 Preparedness and Response. This document provides specified
tasks and suspense dates assigned to Departments for action. The
Framework also categorizes the tasks into four pillars.\1\ DHS utilized
the Framework's pillars and leveraged previous pandemic influenza
planning products to develop the DHS 2009-H1N1 Implementation Plan.
---------------------------------------------------------------------------
\1\ The following are the four pillars established in the National
Framework for 2009-H1N1 Preparedness and Response: Surveillance.--
Enhanced efforts to achieve timely and accurate situational awareness
of evolving disease and the impact on critical sectors to inform policy
and operational decisions; Mitigation Measures.--Interventions to slow
the spread of illness and reduce the impact of infection and illness on
individuals and communities; Vaccination.--Actions to secure safe and
effective vaccines and to ready a national vaccination program to
enable the United States to begin voluntary immunization upon a
recommendation that this approach is warranted; Communications and
Education.--A coordinated campaign to foster a convergence of action
across all levels of government, the private sector, the entire health
care sector, faith-based and community-based organizations, and
individuals.
---------------------------------------------------------------------------
Additionally, after examining the effects of the first wave of
H1N1, DHS collected lessons learned from the initial outbreak, and the
Department provided guidance to components relating to their
preparation for future waves of H1N1. This guidance outlined activities
and timelines associated with the activation and deployment of
component resources and the H1N1 Regional Coordination Teams.
Information from the Framework, DHS lessons learned from the
initial H1N1 outbreak, and guidance to DHS components has been
distilled into a Federal Action Item Matrix containing action items
designed to track and manage the Federal Government's approach to H1N1
response. These action items will address and ameliorate our collective
preparedness and response requirements. We plan to have all action
items resolved and in place by October 15, 2009.
Question 7. How has DHS worked with the coordinating councils to
develop and provide pandemic influenza guidance, clarification of roles
and responsibilities, possible actions (such as border closures), etc.?
Answer. The Department of Homeland Security's (DHS) Partnership and
Outreach Division (POD) has worked closely with representatives from
the Sector-Specific Agencies, Sector Coordinating Councils (SCCs), and
Government Coordinating Councils (GCCs) to develop planning guidance,
and has conducted workshops to assist the private-sector business
community within the critical infrastructure and key resources (CIKR)
sectors in planning for a pandemic influenza outbreak.
In 2006, DHS released the Pandemic Influenza Preparedness,
Response, and Recovery Guide for Critical Infrastructure and Key
Resources (CIKR Pandemic Influenza Guide) and, subsequently, the
individual sector-specific annexes. The CIKR Pandemic Influenza Guide
may be found at www.flu.gov. Since the publication of that Guide in
2006, DHS and subject-matter experts provided by and coordinated
through the respective CIKR SCCs have been drafting individual sector-
specific guides aimed at preparing the sectors for a high-severity
influenza pandemic.
In addition to the Guide, POD worked with the SCCs and GCCs to
develop workshops targeting CIKR business owners and operators and
their contingency planners across the United States. Nine web-based
workshops were conducted during the fall of 2008 for the Commercial
Facilities, Defense Industrial Base, Emergency Services, Energy, Food
and Agriculture, Water, and Information Technology/Communication
sectors. During these workshops, participants had opportunities to ask
questions about the latest USG pandemic planning guidance.
At this time, POD, HHS, and other sector-specific agencies are
reviewing and updating the draft sector-specific guides to ensure
consistency with USG guidance for the 2009-2010 influenza season. When
final, these guides will be disseminated to the sector partners, and
POD will work with those partners on any upcoming activities and
actions. Additionally, implementing a border closure is not part of the
national strategy for responding to a pandemic.
Question 8. Please describe DHS efforts to plan for H1N1 occurring
at the same time as other major incidents, including hurricanes and
acts of biological terrorism.
Answer. The Department of Homeland Security has taken several steps
to prepare for the possibility of a second wave of the H1N1 influenza
occurring simultaneously with other major incidents.
The DHS Office of Operations Coordination and Planning (OPS) and
the Office of Health Affairs (OHA) established an Operational Planning
Team (OPT) to provide surge support to the planning and operational
support efforts needed to augment our capabilities to prepare and
respond to the challenges that 2009 H1N1 presents to the Nation. The
OPT's initial charter laid the foundation for a Federal Strategic
Multi-Incident Plan, to be incorporated within the family of National
Planning Scenarios in the Integrated Planning System, National Planning
Annex I, to Homeland Security Presidential Directive-8.
In developing a draft of this multi-incident plan, the OPT took an
all-hazards approach to address threats that may occur simultaneously
with a 2009 H1N1 influenza outbreak. Special consideration was given to
managing requirements for a major hurricane during an H1N1 outbreak.
Interagency cooperation led to the completion of the draft Federal
Strategic Multi-Incident Plan on July 9, 2009. Participating agencies
included DHS, the Department of Health and Human Services, the
Department of Education, the Department of Transportation, the
Department of Justice, the Department of Defense, the Department of
Commerce, the U.S. Department of Agriculture, the Department of State,
the Department of Labor, the Department of Treasury, and the Department
of Veterans Affairs. Through the information analysis planning process,
threat scenarios, objectives, and tasks were produced. The OPT
developed and analyzed courses of action to address both common all-
hazards threat characteristics and unique scenarios that may occur
simultaneously.
In addition to the work undertaken by the OPT, DHS OPS and FEMA
senior leaders conducted a multi-threat tabletop exercise on August 11,
2009, in which the leadership examined and analyzed the challenges and
response requirements relating to simultaneous response to a second
H1N1 wave and a hurricane in the southeastern United States.
In accordance with the FEMA Pandemic Influenza Plan, FEMA has
activated its Headquarters and Regional Pandemic Response Teams (PRT).
In anticipation of the potential impacts of a pandemic on FEMA, the
PRTs will develop strategies to plan, manage, and coordinate the
effects of a pandemic on our ability to carry out FEMA's mission.
Question 9. What responsibilities does the DHS Science and
Technology Directorate have with respect to addressing pandemic
influenza? Please provide information including specifics regarding all
on-going research, including diagnostic tests.
Answer. The Science and Technology (S&T) Directorate addresses
pandemic influenza by providing technical support for event planning
and response efforts as well as conducting studies to better understand
how disease spreads.
These studies include analyzing potential mitigation strategies to
minimize the spread of influenza outside of the United States, assuming
the outbreak starts in the United States; analyzing the benefits of
various screening strategies for passengers leaving the United States
and entering foreign countries; and analyzing social mitigation
strategies such as social distancing and school closures when
implemented in the United States. These studies seek to determine if
the implementation of a layered approach can delay the peak outbreak in
a foreign country.
S&T is also working on an all-hazards basis to promote resilient
communities. This includes enhancing coordination and cooperation among
first responders and between the public and private sectors; working to
make the States' 211 help systems more effective; developing metrics to
measure the psycho-social impacts of extreme events; and seeking to
better understand and improve official communications regarding degrees
of risk and best steps to mitigate risk.
During an event, the S&T Directorate provides on-call technical
support as needed. In addition, the Biodefense Knowledge Center, funded
by the S&T Directorate and operated out of the Lawrence Livermore
National Laboratory, also supports planning and preparatory efforts by
providing information and rapid response to queries regarding
biological agents such as influenza.
The S&T Directorate is not currently involved in the development of
pandemic influenza diagnostics assays; the Department of Health and
Human Services is the lead for diagnostic-related activities as they
pertain to pandemic influenza.
Question 10. How has the National Biosurveillance Integration
Center maintained constant, real-time, dynamic biosurveillance of the
H1N1 outbreaks/pandemic? Please provide specifics and examples of
reports and products.
Answer. Specific examples include:
NBIC continued/continues to issue reports including specific
H1N1 data on a daily basis. From April 24--September 14, 2009 a
total of 163 reports were prepared providing real-time, dynamic
updates to NBIS Member Agencies (examples attached 20090915
NBIC report and 20090914 NBIC report).
Through an aggressive daily production cycle that ensured
24-hour coverage, NBIC assembled and centralized individual
domain data-feeds utilizing the Biosurveillance Common
Operating Network (BCON).
BCON provided automated data-feed scanning of 2009-H1N1
and related biosurveillance events (at a dynamically
constant rate of approximately 790 sources every 2
hours).\2\
---------------------------------------------------------------------------
\2\ Declared on 11 June 2009.
---------------------------------------------------------------------------
The NBIC aggressively pursued the development of additional
biosurveillance related tools to enable it to provide more timely
information to Federal, State, local, and Tribal leaders; with the
express purpose of enhancing their decision-making in preparation for
the return of H1N1 in the fall of 2009.
Recognizing the potentially devastating consequences on
multiple critical infrastructure areas of the United States,
the NBIC engaged with the National Infrastructure Simulation
and Analysis Center (NISAC) to model potential outbreak
characteristics and infrastructure impacts of a resurgent
novel-H1N1 virus. The results of the NISAC Modeling effort were
analyzed and reviewed by an aggressive and thorough interagency
process that engaged all NBIS Member Agencies and additional
Federal participants (including the Departments of Energy,
Education, and Labor). The impact-analysis was shared with all
of the foregoing departments and agencies to provide additional
insight into ``most-likely scenario'' effects regarding the
anticipated resurgence of H1N1. This NBIC interagency
assessment includes insights regarding the measurable dynamics
associated with the impact of absenteeism, reduction of
productivity and (for example) the perception of the safety of
food commodities that could potentially limit the functionality
of many critical infrastructures and key resources if there is
a resurgence of the 2009-H1N1 novel influenza virus.
With the goal of achieving accurate real-time
interpretation of the output, NBIC hosted specific
interagency collaboration and coordination meetings
regarding the development of the Modeling effort and
Assessment report with the Department of Health and Human
Services (HHS) (including the Centers for Disease Control
and Prevention (CDC)) on 22 July 2009 and the United States
Department of Agriculture (USDA) on August 13, 2009.
To garner specific subject matter and domain-specific
insight, NBIC hosted an interagency collaboration and
coordination conference regarding the development of the
Modeling effort and Assessment report on July 22, 2009.
Participants in the conference or post-conference
discussions included representatives from: NBIS Member
Agencies (State, Defense, Justice (FBI), Interior, USDA,
Commerce, HHS (including CDC and FDA), Transportation,
Veterans Affairs, U.S. Postal Service, EPA); the
Departments of Education, Energy, Labor; and internal DHS
offices including Infrastructure Protection, Intelligence
and Analysis, and the Office of Health Affairs.
Finalization of the assessment is pending the results of a
second modeling run. The parameters for the second run are
being finalized with HHS this week. The modeling run and
subsequent assessment update should be completed by
November 30, 2009.
This Modeling effort can be used to provide further
focus to interagency biosurveillance efforts and associated
analytic efforts regarding key indicators that may result
in earlier cueing and more effective mitigation strategies
as the 2009-H1N1 influenza season unfolds.
A briefing on the NBIC-led, interagency Assessment will
be provided to the Department of Homeland Security
Secretary and Deputy Secretary.
The Executive Summary of the DHS Secretary's briefing
will be shared with other Federal Departments and State and
Local Government Representatives once cleared by DHS
leadership.
Throughout the emergence of the 2009-H1N1 pandemic, the
compilation of biosurveillance information from the NBIS
community continued on a daily basis, including daily
interagency teleconference calls used to create an interagency
cross-domain report.
After receiving updates from interagency SMEs, NBIC
analysts update 2009-H1N1 reports on its main visual and
reporting tool, the Biosurveillance Common Operating
Picture (BCOP).
The BCOP is a geospatial tool that allows users to
review specific in-depth information/reports that are
updated on a daily basis, including the various key
dynamics associated with the likely return of H1N1 to
include a timeline of events, State-by-State case counts,
specific reports about local communities (at such time as
they are developed) and links to the relevant SMEs in the
NBIS community.
NBIC continued/continues to issue reports and update
the BCOP to include specific H1N1 data on a daily basis.
From April 24-September 14, 2009 a total of 163 updates
were prepared providing real-time, dynamic information to
NBIS Member Agencies (attached document 20090914 FED
Worldwide H1N1 Influenza).
To increase the situational awareness of State and
local governmental agencies, the Secretary of DHS approved
the development and deployment of an H1N1-specific BCOP
(one that is accessible by State and local governmental
representatives).
The H1N1-BCOP will be accessible to all validated
State and Local officials through the Homeland Security
Information Network (HSIN) by the end of September 2009.\3\
---------------------------------------------------------------------------
\3\ This differs from the Federal version of the BCOP which allows
users to investigate multiple biological events outside of 2009-H1N1.
---------------------------------------------------------------------------
In coordination with the DHS/Office of Health Affairs (OHA)
H1N1 Overarching Integrated Process Team (DHS/OHA H1N1-OIPT),
the NBIC provides tailored inputs to a special 2009-H1N1 weekly
Situation Report (SITREP). These H1N1-SITREPs inform the
Secretary of DHS and, like the information posted to the BCOP,
are interagency products. The H1N1-SITREP includes information
regarding any potential mutation of 2009-H1N1 or any
coinfection (normal seasonal flu plus H1N1 flu) that could
suggest a change in the lethality or rate of infection among
the population (attached document 20090911 NBIS Input to H1N1
Influenza SITREP).
Question 11. How has the National planning scenario for pandemic
influenza informed DHS plans and response efforts for the H1N1
outbreaks/pandemic? Please provide specifics.
Answer. National Planning Scenario No. 03, Biological Disease
Outbreak--Pandemic Influenza played a significant role in the
development of Federal H1N1 plans and response efforts. The initial
Federal Pandemic Influenza Operations Plan \4\ developed by DHS in
coordination with interagency partners established a solid foundation
that facilitated the rapid development of the 2009 H1N1-specific plans
described in our responses to questions No. 3 and No. 6.
---------------------------------------------------------------------------
\4\ DHS developed a draft of a Federal Pandemic Influenza
Operations Plan (OPLAN) in 2007. This plan was not finalized due to the
October 2007 compression of the 15 National Planning Scenarios into
eight scenario sets by the Homeland Security Council Deputies Committee
and direction by the Deputies that the pandemic influenza scenario
would be last in order of development priority.
---------------------------------------------------------------------------
Question 12. What H1N1 guidance and training have been provided to
DHS personnel in general and in the DHS components specifically (i.e.,
guidance for components, tailored for their specific operations and
challenges)? Please provide copies of these documents to the committee
with the specific dates they were released.
Answer.
Training
On August 20, 2009 Secretary Napolitano presented awareness
information in video format that is available to all DHS employees via
Component intranets as well as the DHS internet webpage. The video can
be viewed at http://www.dhs.gov/files/programs/gc_1241202408781.shtm.
In 2007, the Office of Health Affairs developed a general awareness
video for Pandemic Influenza. This was made available to all Components
to use or include in their learning management system. While not H1N1-
specific it does provide basic influenza prevention.
Multiple Components have developed and conducted specific training
programs. A partial list of training follows:
Customs and Border Protection (CBP).--This Component had been
conducting Pandemic Influenza training for over a year. A partial list
of training classes and the number of employees trained is shown below.
------------------------------------------------------------------------
TRAEN
Module Name Code Number Complete
------------------------------------------------------------------------
Avian Influenza Fundamentals........ 139700 50,267 employees.
Bird Handling Procedures............ 139704 32,479 employees.
PI for International Employees...... 139705 6,461 employees.
PI Safety--Protecting Yourself...... 139701 36,787 employees.
PI Safety--Protecting Your Family... 139702 35,134 employees.
PI Safety--Protecting the Public.... 139703 35,972 employees.
------------------------------------------------------------------------
This list does not include additional respiratory protection,
train-the-trainer for fit-testing, and personal protective equipment
training that were also conducted since this training is also
applicable to other hazards.
FEMA.--FEMA developed a basic training class that is being used at
Presidentially-declared disasters as part of the basic safety
orientation program. This training was completed in May 2009 and has
been in use as needed since that time.
TSA.--Has conducted the class described in the table below: The
Influenza Awareness and Precautions Briefing is estimated to be 40
minutes in length and covers general information on the common cold,
flu and Avian flu, what precautionary steps you can take as well as
outlines the TSA strategic plan and strategy for Pandemic Influenza.
Length: 0.75
Audience: TSA Employees
Contact: ***.*****@tsa.dhs.gov
CPEs: 0.00
Source: Vendor Developed
Contact Hours: 0.75
Goals: Differentiate among the common cold, the common flu, and the
avian flu; Describe the treatment options for each type of ailment;
Identify the preparedness and response measures you can take to protect
yourself and your family; Describe the National Strategy for protecting
the United States from a pandemic flu; Describe TSAs plan for
communicating information about our on-going efforts; Describe the TSA
response plan to a possible avian flu outbreak in the United States.
Credit Hours: 0.75
In addition, TSA posted N95 Respiratory Protection Training to the
Online Learning Center it will be activated in the near future as other
influenza training products are completed, including online H1N1
Awareness Training.
USCIS.--Collateral Duty Safety Officers have participated in formal
training on the USCIS Pandemic Plan and their role in its
implementation. Two special courses are in the final stages of
development. The first course addresses illness in USCIS employees and
a second course deals with ill applicants and visitors to USCIS
offices.
USCG.--The USCG began conducting general awareness training on
Pandemic Influenza approximately 2 years ago, using two different
programs. One is the DHS developed program and the other is a USCG
program that addresses specific USCG situations. In addition to these
programs the USCG also has developed and conducted specialized training
for their three most at-risk groups, Aids to Navigation (due to Avian
Influenza), Boarding and Deployable Operations, and medical personnel
and medical corpsmen.
FLETC.--FLETC has a half day of training planned for all FLETC
management on Safety and Emergency Management. It will include the
Pandemic flu and H1N1, as well as hurricane planning, etc. At present
it is scheduled for Sept 22, though the date may move slightly.
USSS.--Train the trainer for respirator training and for
accomplishing fit-testing at field locations. Approximately 100
personnel initially trained as the trainers. Program will be increased
significantly to accomplish training and fit testing of N95 for our
established mission essential personnel. The target for completion is
training approximately 3,400 employees. Posters are being developed for
deployment throughout the Service. The distribution will occur via e-
mail allowing the field offices to print as many as they need and save
on mail costs. A brochure was developed specifically for the United
Nations General Assembly details. The information will be presented
specifically to the shift leaders for distribution to their teams at
the United Nations. USSS is working on the Avian Pandemic DVD done a
few years ago and re-working it to a smaller content so it can play on
the internal website. The goal is to deploy the program to all
employees but the method and content are still being completed. A
``Pandemic Info'' link has been established on the USSS internal
webpage.
ICE.--ICE began conducting non-mandatory, general awareness
training, via ICE University on pandemic influenza approximately 2\1/2\
years ago. These courses remain available to ICE employees.
Avian/Pandemic Influenza.--This educational module teaches common
ways to avoid catching and spreading the flu, whether pandemic flu or
seasonal flu. This courseware is for FYI purposes only.
Pandemic Influenza Educational Series.--While this course was
originally developed as an awareness training for avian influenza
(H5N1), these training modules present an opportunity to increase
awareness and gain greater understanding of the implications of and
personal protective measures for all types of pandemic influenza. All
ICE employees are encouraged to complete each module in the series and
supervisors are invited to use the modules for roll call training or
similar group training opportunities.
At the outset of the H1N1 influenza outbreak, ICE addressed the use
of facemasks and respirators as a mitigation strategy to decrease the
exposure to the virus for at risk personnel. Specifically, ICE launched
a fit-testing program throughout the United States, training fit
testers. To date, ICE has trained over 10,000 law enforcement and
mission-essential personnel in the use of N95 respirators. The cadre of
over 300 fit testers, located throughout the United States, is well-
positioned to ensure continued protection of the ICE workforce.
In addition, ICE will be conducting a hybrid H1N1 Table Top
Exercise (TTX) over a 3-day session to include senior leadership from
all ICE Program and Field Offices throughout the United States. The ICE
H1N1 TTX is designed to provide an opportunity for every ICE program to
reinforce leadership roles, responsibilities, and authorities while
responding to the current H1N1 event and to engage in discussions about
how ICE will manage its missions and its people in preparation for the
next wave of H1N1.
Guidance
A variety of guidance documents for use Department-wide were
developed by the Office of the Chief Human Capital Office, Office of
Health Affairs, and the Office of the Chief Administrative Officer.
These documents were fully coordinated within DHS and then used to
develop a DHS Employee H1N1 information page. These documents address
risk exposure, personal protective equipment, disinfection, time and
attendance, personnel guidance for managers and supervisors and a host
of H1N1-related topics. The documents and webpage were developed and
constructed during August 2009 with the official announcement of the
page occurring on August 17, 2009. Availability of this information was
highly promoted via Pandemic Planning, occupational safety and health,
and human resources groups. Announcement of the page was the lead story
on the DHS intranet for approximately a week in mid-August. This
guidance provides the basis of workforce protection for all DHS
employees and is being used by Components to develop or refine their
own Pandemic Influenza plans. It should be noted that this page is
undergoing constant review and update as additional information and
guidance becomes available. These documents have been attached to the
main workflow.
Question 13. What exercises have been conducted by DHS regarding
pandemic influenza (including intradepartmental pandemic influenza
tabletops and workshops)? Please provide specific dates, information
regarding attendees, scenarios upon which these exercises were based,
how/whether the Homeland Security Exercise and Evaluation Program
(HSEEP) was used, how the National Exercise Program provided support,
after-action reports, and how information from these exercises
(including after-action reports) were put into LLIS.
Answer.
--------------------------------------------------------------------------------------------------------------------------------------------------------
HSEEP
DHS PI Exercises Type Dates Attendees Scenario Compliance NEP Support? LLIS Reporting?
--------------------------------------------------------------------------------------------------------------------------------------------------------
Intra-DHS.................... Table Top (TTX). Oct 28, 2008.... DHS Component Overseas Yes; standard NEP staff/ Used as central
representatives. outbreak planning liaison information
spreads to US conferences provided for repository
Focus on DHS and technical during
incident documentation. contributions planning and
management. to exercise hosts the
development. after-action
report.
Intra-DHS.................... TTX............. Apr 3, 2009..... DHS Component Overseas Yes; standard NEP staff/ Used as central
representatives. outbreak planning liaison information
spreads to US; conferences provided for repository
Workforce and technical during
protection documentation. contributions planning and
focused. to exercise hosts the
development. after-action
report.
Intra-DHS.................... TTX............. Sept 10, 2009... DHS Assistant Real-world H1N1 Yes; standard NEP staff/ Used as central
Secretaries/ threat; Focus planning liaison information
Component is Continuity conferences provided for repository
leadership. of operations and technical during
and Workforce documentation. contributions planning and
protection. to exercise hosts the
development. after-action
report.
Principal Level Exercise 1-08 TTX............. Feb 2008........ Interagency International Yes; standard NEP sponsored.. No; the White
Deputy outbreak. planning House
Secretaries. conferences maintains
and control of the
documentation. Summary of
Conclusions.
Through the Regional Exercise Workshops, ................ All levels/ Various......... Yes; especially Sponsor of Various means
Support Program, DHS/FEMA Seminars, TTX's jurisdictions; those exercise of information
has sponsored exercises Functional, including utilizing DHS support--prima management.
across the US at various Full scale. senior funding. rily through
levels of government. officials. the Regional
Exercise
Support
Program.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Question 14. How do the recently created Regional Coordination
Teams for pandemic influenza differ from the previously established
teams? Please provide specifics.
Answer. The previous National Pandemic Influenza Principal Federal
Official (NPI-PFO) team included a national Principal Federal Official
for a pandemic event, as well as NPI-PFO field teams. For the H1N1
influenza outbreak, Secretary Napolitano elected to serve as the sole
Principal Federal Official and replace the NPI-PFO field teams with
reconfigured H1N1 Regional Coordination Teams (RCTs), To reflect these
modifications, the pandemic ``regions,'' their associated staffing, and
responsibilities as outlined in the NPI-PFO structure have been renamed
and reconfigured to reflect Secretary Napolitano's intent. The H1N1 RCT
structure and mission reflect those necessary changes.
Secretary Napolitano has outlined the following seven missions for
the RCTs:
1. Serve as a conduit between the many Federal agencies engaged in
H1N1 response efforts and DHS's various partners in the States;
2. Identify, and respond, through previously established incident
management architecture, to critical information requirements,
enabling the Secretary to make decisions related to the
Secretary's role as the Principal Federal Official for the H1N1
Pandemic;
3. Serve as the Secretary's primary source in the field for
awareness of strategic issues related to the H1N1 pandemic and
help broker resolution of significant disputed issues;
4. Identify and help reconcile regional conflicts involving varying
social distancing policies and national resources, especially
those affecting commercial activities outside of a single
Robert T. Stafford Disaster Relief and Emergency Assistance
Act, Public Law 100-707, declaration ``affected area'' and
during a compressed time cycle;
5. Report through the FEMA Regional Administrator and the Federal
Coordinating Officer (FCO). This will ensure that the FEMA
Regional Administrators can focus on emergency management and
regional administration functions and the FCOs can focus on and
lead the administration and coordination of relief at the
operational and tactical levels as required by law;
6. Assist DHS component and other Federal interagency leaders in
the field to coordinate and collaborate to achieve nationally
directed strategic objectives, including those related to entry
and exit screening, quarantine, isolation, vaccination,
continuity of operations, and continuity of government;
7. Coordinate with the Designated Agency Safety and Health Official
within DHS, Components, and other Department and Agency safety
officers in the field through the chair and appropriate members
of the DHS Safety and Occupational Health Committee, on all
action affecting personnel regarding personal protective
equipment and distribution of anti-viral medications.
Question 15. In your testimony, you stated that personal protective
equipment has been prepositioned at 120 DHS locations and field offices
Nation-wide. Where are these locations and to which offices are they
assigned?
Answer.
U.S. Immigration and Customs Enforcement (ICE)
ICE National Capitol Region
ICE Alternate Operating Facility
ICE SAC Atlanta, GA; ICE SAC Baltimore, MD; ICE SAC Boston, MA; ICE SAC
Buffalo, NY; ICE SAC Chicago, IL; ICE SAC Irving, TX; ICE SAC Denver,
CO; ICE SAC Detroit, MI; ICE SAC El Paso, TX; ICE SAC Honolulu, HI; ICE
SAC Houston, TX; ICE SAC Los Angeles, CA; ICE SAC Miami, FL; ICE SAC
New Orleans, LA; ICE SAC New York, NY; ICE SAC Newark, NJ; ICE SAC
Philadelphia, PA; ICE SAC Phoenix, AZ; ICE SAC San Antonio, TX; ICE SAC
San Diego, CA; ICE SAC San Francisco, CA; ICE SAC San Juan, Puerto
Rico; ICE SAC Seattle, WA; ICE SAC St. Paul, MN; ICE SAC Tampa, FL; ICE
SAC Washington, DC; ICE FOD Atlanta, GA; ICE FOD Boston, MA; ICE FOD
Buffalo, NY; ICE FOD Chicago, IL; ICE FOD Dallas, TX; ICE FOD Denver,
CO; ICE FOD Detroit, MI; ICE FOD El Paso, TX; ICE FOD Houston, TX; ICE
FOD Los Angeles, CA; ICE FOD Miami, FL; ICE FOD Newark, NJ; ICE FOD New
Orleans, LA; ICE FOD New York, NY; ICE FOD Philadelphia, PA; ICE FOD
Phoenix, AZ; ICE FOD Salt Lake City, UT; ICE FOD San Antonio, TX; ICE
FOD San Diego, CA; ICE FOD San Francisco, CA; ICE FOD Seattle, WA; ICE
FOD Saint Paul, MN; ICE FOD Washington, DC. Total--51 ICE Locations.
CBP Air Cargo, Humble, TX; CBP Laredo, TX; CBP Price Main (ATCET)
Carson, CA; CBP--Miami International Airport; CBP New Orleans,
Louisiana 70112; CBP Newark, NJ 07102; CBP Jamaica, NY; CBP Portland,
OR; CBP San Diego, Otay Mesa Commercial Facility; Area Port of San
Francisco; CBP San Juan Puerto Rico; CBP Seattle, WA; Area Port of
Tampa; Area Port: Orlando; Area Port: Jacksonville; Mariposa Port of
Entry. Total--23 CBP locations.
DHS TSA Warehouse
GSA Distribution Center
Springfield, VA 22150
Total--TSA
DHS STOCKPILE
Cumberland Logistics Center (FEMA)
USCG central warehousing operations:
Harrisonburg, VA
USCG Locations the PPE Push Packs were pre-positioned:
Charlevoix, MI 49720-9999
Duluth, MN 55802-2492
USCGC ASPEN (WLB-208)
San Francisco, CA 94130-5013
USCGC CYPRESS (WLB-210)
Mobile, AL 36615-1390
USCGC ELM (WLB-204)
Atlantic Beach, NC 28512-5633
USCGC FIR (WLB-213)
Astoria, OR 97103
USCGC HICKORY (WLB-212)
Homer, AK 99603-0101
USCGC HOLLYHOCK (WLB-214)
Port Huron, MI 48060
USCGC JUNIPER (WLB-201)
Newport, RI 02841-1716
USCGC KUKUI (WLB-203)
USCGC MAPLE (WLB-207)
Sitka, AK 99835-9454
USCGC OAK (WLB-211)
Charleston, SC 29405-2421
USCGC SEQUOIA (WLB-215)
USCGC SPAR (WLB-206)
Kodiak, AK 99619-0651
USCGC SYCAMORE (WLB-209)
Cordova, AK 99574
USCGC WALNUT (WLB-205)
Honolulu, HI 96819
USCGC WILLOW (WLB-202)
Newport, RI 02841-1716
USCGC ABBIE BURGESS (WLM-553)
Rockland, ME 04841-3417
USCGC ANTHONY PETIT (WLM-558)
Ketchikan, AK 99901
USCGC BARBARA MABRITY (WLM-559)
Mobile, AL 36615-1390
USCGC FRANK DREW (WLM-557)
Portsmouth, VA 23703-2703
USCGC GEORGE COBB (WLM-564)
San Pedro, CA 90731-0208
USCGC HARRY CLAIBORNE (WLM-561)
Galveston, TX 77553
USCGC HENRY BLAKE (WLM-563)
Everett, WA 98207-5001
USCGC IDA LEWIS (WLM-551)
Newport, RI 02841-1716
USCGC JAMES RANKIN (WLM-555)
Baltimore, MD 21226-2703
USCGC JOSHUA APPLEBY (WLM-556)
St Petersburg, FL 33701-5099
USCGC KATHERINE WALKER (WLM-552)
Bayonne, NJ 07002-5041
USCGC MARCUS HANNA (WLM-554)
South Portland, ME 04106-0007
USCGC MARIA BRAY (WLM-562)
Atlantic Beach, FL 32233
USCGC WILLIAM TATE (WLM-560)
Philadelphia, PA 19147
USCGC BLUEBELL (WLI-313)
Portland, OR 97217-3992
USCGC BUCKTHORN (WLI-642)
Sault Ste. Marie, MI 49783-9501
USCGC BAYBERRY (WLI-65400)
Seattle, WA 98134-1192
USCGC BLACKBERRY (WLI-65303)
Long Beach, NC 28465-8443
USCGC ELDERBERRY (WLI-65401)
Petersburg, AK 99833-0550
USCGC ANVIL (WLIC-75301)
Charleston, SC 29401-1817
USCGC AXE (WLIC-75310)
Morgan City, LA 70380-6030
USCGC CLAMP (WLIC-75306)
Galveston, TX 77553-3001
USCGC HAMMER (WLIC-75302)
Mayport, FL 32233
USCGC HATCHET (WLIC-75309)
Galveston, TX 77553-3001
USCGC HUDSON (WLIC-801)
Miami Beach, FL 33139-5101
USCGC KENNEBEC (WLIC-802)
Portsmouth, VA 23703-2199
USCGC PAMLICO (WLIC-800)
New Orleans, LA 70117-4698
USCGC SAGINAW (WLIC-803)
Mobile, AL 36615-1390
USCGC SLEDGE (WLIC-75303)
Baltimore, MD 21226-2704
USCGC SMILAX (WLIC-315)
Atlantic Beach, NC 28512-5633
USCGC VISE (WLIC-75305)
St. Petersburg, FL 33701-5030
USCGC CHENA (WLR-75409)
Hickman, KY 42050-1132
USCGC CHEYENNE (WLR-75405)
St. Louis, MO 63118-3284
USCGC CHIPPEWA (WLR-75404)
Buchanan, TN 38222-7181
USCGC CIMARRON (WLR-65502)
Buchanan, TN 38222-4201
USCGC GASCONADE (WLR-75401)
Omaha, NE 68112-0337
USCGC GREENBRIER (WLR-75501)
Natchez, MS 39122-8909
USCGC KANAWHA (WLR-75407)
Pine Bluff, AR 71611-7627
USCGC KANKAKEE (WLR-75500)
Memphis, TN 38105-1502
USCGC KICKAPOO (WLR-75406)
Vicksburg, MS 39180-0031
USCGC MUSKINGUM (WLR-75402)
Sallisaw, OK 74955-0626
USCGC OBION (WLR-65503)
Owensboro, KY 42303-0277
USCGC OSAGE (WLR-65505)
Sewickley, PA 15143-2093
USCGC OUACHITA (WLR-65501)
E. Chattanooga, TN 37416-2825
USCGC PATOKA (WLR-75408)
Greenville, MS 38701-9584
USCGC SANGAMON (WLR-65506)
East Peoria, IL 61601-2039
USCGC SCIOTO (WLR-65504)
Keokuk, IA 52632-5851
USCGC WEDGE (WLR-75307)
Demopolis, AL 36732-9999
USCGC WYACONDA (WLR-75403)
Dubuque, IA 52001-7652
USCG total buoy tenders: 66.
Delivery locations for prepositioning of surgical masks:
CBP Warehouse
Indianapolis, IN 46278
USCG 1: Attn: USCG Pandemic Stockpile
DHS 1: Attn: DHS PPE Stockpile Program
Cumberland Logistics Center (FEMA)
USCIS 1: Attn: USCIS Pandemic Stockpile
FEMA 1: Distribution Center--Atlanta
FEMA 2: Distribution Center--Ft. Worth
FEMA 3: Distribution Center--Moffett Field
FEMA 4: Distribution Center--Frederick
FEMA 5: Cumberland Distribution Center
MTW 1: Mount Weather Emergency Operations Center
USSS 1: U.S. Secret Service
Beltsville, MD 20708
NCR 1: DHS National Capital Region
Question 16. Please provide copies of all of the employee messages
that were distributed by DHS and its components regarding H1N1
guidance.
Answer. Attached to the main workflow are copies (15) of the
employee messages that were distributed to DHS.*
---------------------------------------------------------------------------
* The information has been retained in committee files.
---------------------------------------------------------------------------
Please note that some of the early guidance has been revised and
superseded based on advice from OSHA and CDC as more was learned about
H1N1.
Question 17. Has the Department established vaccine priorities for
which employees will receive H1N1 immunization first? If so, please
describe these priorities and the criteria used to develop these
priorities.
Answer. Based on HHS/CDC H1N1 vaccine target group recommendations,
the Department of Homeland Security (DHS) has prescribed vaccine
prioritization for its Federal employees who fall into the five
priority groups of health care and emergency medical services workers,
pregnant women, those employees 24 years of age or younger, persons
aged 25-64 years of age with underlying health conditions associated
with higher risks of medical complications from influenza, and
household contacts and caregivers for children under 6 months of age.
DHS will follow HHS, CDC, and the Office of Personnel Management's
(OPM) publication, ``Preparing for the Flu: A Communications Toolkit
for the Federal Workforce'' at http://www.flu.gov/professional/federal/
workplace/federal_toolkit.pdf and will determine the prioritization of
its employees for H1N1 vaccine in accordance with the groups
recommended at http://www.cdc.gov/h1n1flu/vaccination/acip.htm. OHA has
taken measures to ensure DHS operational components identify both
mission critical and emergency personnel.
Questions From Chairman Bennie G. Thompson of Mississippi for William
Corr, Deputy Secretary, Department of Health and Human Services
Question 1. When will clinical trials for the H1N1 vaccine be
completed?
Answer. With its sister agencies in the Department of Health and
Human Services, the National Institute of Allergy and Infectious
Diseases (NIAID), a component of the National Institutes of Health
(NIH), has designed and is in the process of implementing clinical
trials for the novel H1N1 2009 influenza vaccine through the Nation-
wide network of NIAID Vaccine and Treatment Evaluation Units (VTEUs).
Data from these trials will provide knowledge to help inform public
health policy decisions and provide guidance for the 2009-H1N1
immunization plan. The initial NIAID-supported H1N1 trials are designed
to answer three primary questions:
Are these vaccines well-tolerated in healthy people of
various ages?
How large of a vaccine dose, and how many doses of vaccine,
are needed to induce an immune response that is predictive of
protection?
Can 2009-H1N1 influenza vaccine be safely administered at
the same time or sequentially with the seasonal influenza
vaccine, and will both vaccines induce protective immune
responses?
These studies are assessing the vaccines in multiple age groups,
including children aged 6 months and older, healthy adults, and healthy
elderly adults over 65 years of age. Complete immune response data from
the first trials--those studying two doses in healthy adults--are
expected in late October. Preliminary data indicate that the vaccines
are safe and that a single 15-microgram dose induces what is likely to
be a protective immune response in healthy adults between the ages of
18 and 64. For adults aged 65 and over, the preliminary data indicate
that the immune response to the 2009-H1N1 influenza vaccine is less
robust, as is the case with seasonal influenza vaccine. Data on how the
pediatric populations respond immunologically following a first and
second dose of H1N1 vaccine are expected in mid-November. Early data
from the pediatric trials suggest that one dose of vaccine in older
children, aged 10 to 17 years, may be adequate to induce a robust
immune response. Younger children may require a second dose, as is the
case with seasonal influenza vaccine. Complete immune response data
from studies of administration of the 2009-H1N1 influenza vaccine with
the seasonal influenza vaccine in both adults and children are expected
to be available by mid-December. Preliminary data are expected to be
available in October.
In addition to these initial trials, NIAID is supporting additional
studies in populations who may be at higher risk of complications from
influenza. For example, the first clinical trial of 2009-H1N1 influenza
vaccine in pregnant women began on September 9; preliminary data are
expected in late October. Additional trials in pregnant women are
expected to begin in late October. Clinical trials of the vaccine in
other populations are in development.
Finally, NIAID is supporting trials of 2009-H1N1 influenza vaccines
with adjuvants, which are additives that help create a more vigorous
immune response to a vaccine. These trials are expected to begin in
mid-September, with the first preliminary immune response data expected
in mid- to late October.
In addition, five manufacturers licensed by FDA to produce seasonal
influenza vaccine for the United States are also conducting clinical
studies with the H1N1. These studies were designed with guidance from
FDA to evaluate the immune response to the vaccine, and determine the
optimal dose. The populations studied by the various manufacturers
include children 6 months of age and older, adults, and the elderly.
The preliminary results from the manufacturers' clinical studies
regarding the number of doses and the immune response induced are
consistent with the results of the NIH studies discussed above. The
trials are on-going.
Question 2. Please describe HHS efforts to plan for H1N1 occurring
at the same time as other major incidents, including hurricanes and
acts of biological terrorism.
Answer. Multiple simultaneous events are always a possibility, and
over the years the Department has responded to co-occurring events.
There are playbooks to guide the response for each type of event, and
the Secretary's Operations Center coordinates the response to each
event. To plan specifically for an H1N1 outbreak occurring at the same
time as a hurricane, the Office of the Assistant Secretary of
Preparedness and Response (ASPR), the Office of Preparedness and
Emergency Operations (OPEO) conducted four 3-hour tabletop exercises,
titled ``HHS Preparation to Respond to Multiple Events Tabletop
Exercise--Steps to Responsiveness'' between May and July 2009.
Our purpose in conducting this series of tabletop exercises was to
share knowledge and gain an understanding of how each ASPR organization
would respond and integrate into the overall ESF No. 8 response. Our
method was to build each exercise on the previous exercise discussions,
focusing on OPEO considerations in response to an impending hurricane
and on-going influenza outbreak, relationships between Emergency
Management Group entities, and team preparedness, and readiness
considerations. The exercises assisted in achieving the following
objectives:
Identify command and control procedures and structures when
dealing with multiple ESF No. 8 events.
Understand capabilities and expectations for resource and
volunteer management.
Identify and establish expectations for evacuation, mass
care, and patient movement.
Question 3. Will the antivirals in the National stockpile be
replenished on an on-going basis? If so, how often and what are the
challenges in doing so?
Answer. All of the antiviral drugs that were released in the spring
from the Strategic National Stockpile (SNS) have been replenished.
Future decisions to replenish antiviral drugs will be made based on
need for product, available manufacturer supply and available funding.
Question 4. Which traditional surveillance systems were and are
used by the Centers for Disease Control and Prevention to track the
progress of the novel H1N1 outbreaks/pandemic?
Answer. The Epidemiology and Prevention Branch in the Influenza
Division at CDC collects, compiles, and analyzes information on
influenza activity year-round in the United States and produces a
weekly report from October through mid-May. The U.S. influenza
surveillance system is a collaborative effort between CDC and its many
partners in State and local health departments, public health and
clinical laboratories, vital statistics offices, health care providers,
clinics, and emergency departments. Information in five categories is
collected from nine different data sources.
Viral Surveillance.--About 80 U.S. World Health Organization
(WHO) Collaborating Laboratories and 70 National Respiratory
and Enteric Virus Surveillance System (NREVSS) laboratories,
located throughout the United States, participate in virologic
surveillance for influenza. All State public health
laboratories participate as WHO collaborating laboratories
along with some county public health laboratories and some
large tertiary care or academic medical centers. Most NREVSS
laboratories participating in influenza surveillance are
hospital laboratories. In 2007, human infection with a novel
influenza A virus became a nationally notifiable condition. The
2009 influenza A (H1N1) virus is a novel virus. Novel influenza
A virus infections include all human infections with influenza
A viruses that are different from currently circulating human
influenza H1 and H3 viruses.
Outpatient Illness Surveillance.--Information on patient
visits to health care providers for influenza-like illness is
collected through the U.S. Outpatient Influenza-like Illness
Surveillance Network (ILINet).
Mortality Surveillance.--Rapid tracking of influenza-
associated deaths is done through two systems:
122 Cities Mortality Reporting System. Each week, the
vital statistics offices of 122 cities report the total
number of death certificates received and the number of
those for which pneumonia or influenza was listed as the
underlying or contributing cause of death by age group. The
percentage of all deaths due to pneumonia and influenza
(P&I) are compared with a seasonal baseline and epidemic
threshold value calculated for each week.
Surveillance for Influenza-associated Pediatric Mortality.
Influenza-associated deaths in children (persons less than
18 years) was added as a nationally notifiable condition in
2004. Laboratory-confirmed influenza-associated deaths in
children are reported through the Nationally Notifiable
Disease Surveillance System.
Hospitalization Surveillance.--Two systems monitor
hospitalizations with laboratory confirmed influenza
infections.
Emerging Infections Program (EIP). The EIP Influenza
Project conducts surveillance for laboratory-confirmed
influenza related hospitalizations in children (persons
less than 18 years) and adults in 60 counties covering 12
metropolitan areas of 10 States (San Francisco, CA; Denver,
CO; New Haven, CT; Atlanta, GA; Baltimore, MD; Minneapolis/
St. Paul, MN; Albuquerque, NM; Las Cruces, NM; Albany, NY;
Rochester, NY; Portland, OR; and Nashville, TN).
New Vaccine Surveillance Network (NVSN). The New Vaccine
Surveillance Network (NVSN) provides population-based
estimates of laboratory-confirmed influenza hospitalization
rates for children less than 5 years old residing in three
counties: Hamilton County, OH; Davidson County, TN; and
Monroe County, NY.
Summary of the Geographic Spread of Influenza.--State health
departments report the estimated level of spread of influenza
activity in their States each week through the State and
Territorial Epidemiologists Reports. States report influenza
activity as no activity, sporadic, local, regional, or
widespread.
For a more detailed explanation of these influenza surveillance
systems visit: Flu Activity and Surveillance.
Question 5. Which vaccine manufacturers are providing bulk
components for the H1N1 vaccine? Are these the same manufacturers who
already produce U.S.-licensed seasonal vaccine? If not, please provide
the list of these manufacturers as well.
Answer. Six manufacturers are licensed to manufacture seasonal
influenza vaccine in the United States: CSL Limited, GlaxoSmithKline
Biologicals, ID Biomedical Corp of Quebec, MedImmune, LLS, Novartis
Vaccines and Diagnostics Limited, and sanofi pasteur Inc.
On September 15, 2009, FDA-approved supplements to the existing
Biologics License Applications from four of these licensed influenza
manufacturers to include Influenza A (H1N1) 2009 Monovalent Vaccine.
These vaccines are made by CSL Limited, MedImmune LLC., Novartis
Vaccines and Diagnostics, Limited, and sanofi pasteur, Inc. These
manufacturers make their own bulk components; however, they will
provide the monovalent Influenza A (H1N1) 2009 in final finished
containers, not in bulk form.
Questions From Ranking Member Peter T. King of New York for William
Corr, Deputy Secretary, Department of Health and Human Services
Question 1a. While a vaccine is a critical component of the
National strategy to mitigate pandemic influenza, other non-
pharmaceutical tools also have the potential to limit disease and play
an important role in a dynamic influenza strategy. In terms of a point-
of-care diagnostic that can determine a pandemic strain for the coming
influenza season, does HHS: See value in, and
Answer. Yes, HHS/ASPR sees value in point-of-care diagnostics.
Question 1b. Plan to procure such a piece of technology?
Answer. HHS/ASPR and HHS/CDC together invested in development of
point-of-care influenza diagnostic detection systems. It was an
investigational test of such a system that was used as part of a
clinical evaluation in the first case of 2009-H1N1 in California.
Question 2a. In terms of personal protective equipment (PPE): What
is HHS' response to the claim that the National stockpile contains only
enough face masks to provide for the American population for 3 days?
Answer. The Strategic National Stockpile (SNS) includes respirators
and facemasks, but they are not intended to be used to help protect the
general American population. The respirators and facemasks in the SNS
are intended to be provided to States to help protect health care
workers in accordance with published guidance for use. CDC's guidance
recommends the use of respirators primarily for health care workers in
close contact with patients with influenza-like illness (ILI) and the
use of facemasks by patients with ILI while they are in a health care
setting to limit the spread of influenza. CDC's guidance generally does
not recommend the use of respirators or facemasks for workers in non-
health care occupational settings for general work activities or in
community and home settings except in certain circumstances for persons
at increased risk of severe illness from influenza.
Question 2b. Has HHS considered procuring advanced but commercially
available PPE technologies, such as masks and gowns that neutralize
virus particles?
Answer. Issuing contracts for the purchase of PPE is a competitive
process. HHS contract requirements for the purchase of PPE are set
according to Federal acquisition regulations and do not exclude the
purchase of PPE with antimicrobial properties. To date, HHS has
purchased respirators for critical workforce from three vendors on the
GSA supply schedule competitive process.
Question 3. Lastly, can BioShield funds be used for pandemic
influenza procurements, whether pharmaceutical or non-pharmaceutical in
nature?
Answer. No. BioShield funds support the procurement and advanced
development of medical countermeasures for chemical, biological,
radiological, and nuclear agents.
Questions From the Honorable Michael T. McCaul of Texas for William
Corr, Deputy Secretary, Department of Health and Human Services
Question 1a. In your testimony, you stated that the number of
antiviral courses States have on hand is 35 million and the size of the
Strategic National Stockpile (SNS) is between 75-100 million. According
to information obtained from the Department of Health and Human
Services, however, the SNS currently holds over 48 million regimens of
antiviral drugs, with States holding an additional 23 million regimens
(prior to the H1N1 response).
Can you please clarify the discrepancy in these figures?
Question 1b. Will the supplies on hand be sufficient for a second
wave of pandemic flu occurring concurrently with seasonal flu? Or do
you plan to purchase more antivirals?
Answer. Prior to H1N1, States bought 23.5 million treatment courses
of antivirals for their stockpiles and HHS had 50 million treatment
courses of antivirals in the SNS. In May 2009, with the H1N1 outbreaks
in the United States, 11.5 million treatment courses of antivirals were
deployed pro-rata to the States. Additionally, nearly 1 million
treatment courses were provided to Mexico and other countries.
Subsequently, HHS replenished the antiviral stockpile by purchasing 13
million treatment courses of antivirals. Additionally, States purchased
another 2.1 million treatment courses of antivirals for their
stockpiles, bringing the total amount of antivirals in States to about
37.1 million treatment courses.
HHS is awaiting delivery of an additional 1 million treatment
courses of antiviral drugs and has plans to procure more antiviral
drugs upon availability of contingency funds.
Questions From Chairman Bennie G. Thompson of Mississippi for Ms.
Bernice Steinhardt, Director, Strategic Issues, Government
Accountability Office
Question 1. Which recommendations from GAO's work on pandemic
influenza remain open? What is the current status, given recent changes
(e.g. the combining of the Homeland and National Security Councils, the
new DHS regional coordination teams)?
Answer. As of July 2009, GAO has made 24 pandemic preparedness
recommendations that Federal agencies have generally agreed to. There
have been 11 recommendations, however, that have not yet been fully
implemented. Several of these open recommendations are particularly
relevant to planning and preparedness for the 2009 H1N1 pandemic in the
coming months.
First, given the change in administration and the associated
transition of senior Federal officials, the shared leadership
roles that have been established between HHS and DHS for a
pandemic, along with other responsible Federal officials,
should be rigorously tested and exercised.
Second, the 3-year period covered by the National Pandemic
Implementation Plan is now over and it will be important for
the White House National Security Staff (NSS), which supports
the Homeland Security Council (HSC) in this administration, to
establish a process for updating the National Pandemic
Implementation Plan so that the updated plan can address the
gaps we have identified, as well as lessons learned from the
2009 H1N1 pandemic.
Third, DHS should continue to work with other Federal
agencies and private sector members of the critical
infrastructure coordinating councils to help address the
challenges of coordination and clarify roles and
responsibilities of Federal and State governments.
Fourth, although HHS, DHS, Education, and the White House
hosted an H1N1 summit in July 2009 to aid State and local
governments in pandemic planning, DHS and HHS could also hold
additional meetings with States to help them address previously
identified gaps in their pandemic planning.
Finally, greater monitoring and reporting of agencies'
progress in plans to protect their workers during a pandemic
are needed to insure the readiness of agencies to continue
operations while protecting their employees in the event of a
pandemic.
Questions From Ranking Member Peter T. King of New York for Ms. Bernice
Steinhardt, Director, Strategic Issues, Government Accountability
Office
Question 1a. GAO has found that there is no mechanism in place to
monitor agencies' progress in developing workforce protection plans.
DHS was charged with this responsibility, but the Homeland Security
Council has not mandated this.
Why do you feel DHS is the right agency to handle this
responsibility?
Answer. The National Security Presidential Directive/NSPD 51
designates the Secretary of Homeland Security to serve as the
President's lead agent for coordinating overall continuity operations
and activities of executive departments and agencies. Among other
responsibilities, the Secretary is directed to ``Coordinate the
implementation, execution, and assessment of continuity operations and
activities''. As we reported in June 2009, the primary threat to
continuity of operations during a pandemic is the threat to employee
health.
Agencies' protection of its workforce from infection is a key
element of pandemic influenza operational plans. As originally
envisioned under the Homeland Security Council's (HSC) Implementation
Plan for the National Strategy for Pandemic Influenza, DHS was charged
with, among other things, monitoring and reporting to the Executive
Office of the President on the readiness of departments and agencies to
continue their operations while protecting their workers during an
influenza pandemic. Although DHS officials said they were subsequently
informed that they did not have to prepare a report, having DHS monitor
and report on the status of agencies' pandemic plans to protect the
safety and health of their employees while maintaining essential
operations could enhance agencies' accountability for this
responsibility and serve as an effective way of tracking agencies'
progress in making their pandemic plans operational by planning for the
protection of their workforce.
Question 1b. What office within DHS should handle this?
Answer. The scope of our report did not include an assessment of
which DHS office or offices should be selected to lead or manage the
assessments.
Question From Chairman Bennie G. Thompson of Mississippi for Ms.
Colleen M. Kelley, National President, National Treasury Employees
Union
Question. Does NTEU have a position on which Federal workers should
get vaccinated against H1N1 first?
Answer. NTEU's position is that Federal employees whose jobs
necessitate their close interaction with and proximity to the public,
such as Customs and Border Protection (CBP) Officers, CBP Agriculture
Specialists, and Transportation Security Officers in inspection
positions at domestic airports and U.S. air, sea, and land ports of
entry, should be among the first to be provided with the vaccine, if
agencies distribute it to workers. The choice to get vaccinated,
however, should be the choice of the Federal employee and not mandated.
Questions From Chairman Bennie G. Thompson of Mississippi for Mr.
Richard G. Muth, Executive Director, Maryland Emergency Management
Agency
Question 1. In your testimony, you refer to the need for greater
consistency between public health and emergency management planning
guidance so that the various agencies can work together seamlessly.
What guidance were you referring to? Please provide specific examples.
Answer.
Guidance for emergency management planning generally is
directed by the Comprehensive Planning Guidance and other
paradigms, such as NUREG for nuclear planning.
Planning guidance differs as MEMA uses standard emergency
management planning guidance while other agencies including the
Maryland Department of Health and Mental Hygiene are required
to use CDC guidance.
NIMS/ICS is Federally required but this is not adhered to by
all entities.
Scalability and flexibility is essential. Unfortunately,
these were not found in all State flu planning; the Strategic
National Stockpile Plan (SNS) especially needs to have these
characteristics.
Unintended consequences:
Plans must be integrated in similar formats with all State
hazard events in mind. When these commonalities do not occur,
operational staff using the plans, those committing resources
and decision makers at the highest levels are unable to fulfill
their responsibilities. Thus, resources can be wasted,
decisions poorly drawn and, most critically, citizens can be
put at risk.
Question 2. What criteria will the State use to determine
activation of the Emergency Operations Center in response to the H1N1
influenza pandemic?
The State Emergency Operations Center (SEOC) at MEMA is
always at Level 1 through its 24/7 Maryland Joint Operations
Center (MJOC). This capability is available for all-hazard
efforts.
Pursuant to criteria in State law, when more than two State
departments are involved in an incident, the Level of the SEOC
may be raised to accommodate the incident.
State staff is called in via an automated call-down system.
While H1N1 may have some unique features, it will be treated
as a ``Notice Event'' meaning that MEMA is aware of its
occurrence, similar to a hurricane and Levels will be increased
as required.
As with other health incidents, DHMH is the lead State
agency, the subject matter experts as it were and MEMA
coordinator of operations and State resources.
Consequence/benefits:
Maintaining standardized levels and adherence to State law
and procedures in an all-hazards posture allows for the most
efficient and reliable means of operation before and during an
incident.
Standardization further creates an atmosphere of ``no
surprises'' or as few as possible when dealing with
emergencies.
Staff from MEMA and any other involved State agency has been
trained on and is knowledgeable of procedures and anticipated
actions.
Questions From Chairman Bennie G. Thompson of Mississippi for Dr. Mark
B. Horton, Director, California Department of Public Health
Question 1. Do you believe there is a need for greater consistency
between public health and emergency management planning guidance so
that the various agencies can work together seamlessly? If so, please
provide examples specific to the State of California. If not, why not?
Answer. In California, the California Emergency Management Agency
(CalEMA) recognized that the H1N1 outbreak was a public health disaster
and that an effective response required public health to lead
California's efforts. CalEMA provided (and continues to provide)
support to the State's public health infrastructure which includes our
sister department, the Emergency Medical Services Authority (EMSA).
We do believe there is a need for greater coordination between
public health and emergency management functions at the Federal level.
From the State perspective it often appeared that was not a clear
articulation of roles and responsibilities between the Health and Human
Services Agency and the Department of Homeland Security. For example
there appeared to be overlap between the two organizations with respect
to public communications, requests to States for information and
reporting requirements. From a public information standpoint, the first
issue has been recently resolved with the institution of jointly-hosted
conference calls. To sustain an adequate response to the continued
outbreak, it will be necessary to ensure that there is a common
understanding of roles and responsibilities, coordination of timelines,
consistency of public information and guidance, and integration across
funding streams. Absent that understanding by all concerned it will be
difficult to mount an integrated medical response if public health
first responders are faced with reporting within multiple command
structures.
It is important to note that this outbreak has clearly demonstrated
the need to identify specific funding to ensure that emergency
preparedness policy and funding decisions continue to include all-
hazard preparedness for public health in addition to first responders
such as police and fire.
Question 2. What criteria will the State use to determine
activation of the Emergency Operations Center in response to the H1N1
influenza pandemic?
Answer. In California, the Joint Emergency Operating Center (JEOC)
is currently operating at a moderate level of activation to coordinate
response efforts across Federal, State, and local agencies for the on-
going H1N1 emergency State-wide. CDPH and EMSA are coordinating with
CalEMA to identify trigger points for more intense activation status.
The State response in April, 2009 was guided by The Pandemic
Influenza Preparedness and Response Plan, as adopted by CDPH (then the
Department of Health Services) in September 2006. The Plan indicates
that the first case of laboratory-confirmed novel influenza virus human
infection in California or elsewhere in the United States, or evidence
of sustained human-to-human transmission anywhere in the world, will
result in activation of the relevant components of the emergency
management organization and may trigger a Governor's proclamation of a
state of emergency. On Friday, April 17, 2009, the Centers for Disease
Control, through laboratory data supplied by the Federal Border
Infectious Disease Surveillance (BIDs) program office located in San
Diego, determined that two California influenza cases had a unique
combination of gene segments not previously reported among swine or
human influenza viruses in the United States or elsewhere. CDPH staff
worked through the weekend with CDC staff to collect additional
information. Although human-to-human transmission had not yet been
verified, on Monday, April 21, 2009 the CDPH Joint Emergency Operation
Center (JEOC) went to full activation. On April 28, 2009, the Governor
declared a state of emergency.
Operational levels are commensurate with the level of H1N1 activity
in the State and appear adequate at this time. Activation status is
regularly reviewed by emergency support personnel and staffing and
resources are constantly reassessed. Given that we are at a higher
stage of alert and in a proclaimed State of Emergency for public
health, activation status will remain elevated throughout the pandemic,
even as State Operations Center (SOC) and JEOC staffing levels
fluctuate based on demand from differing disciplines.
Questions From Chairman Bennie G. Thompson of Mississippi for Dr.
Thomas A. Farley, New York City Department of Health and Mental Hygiene
Question 1. How is New York City modifying its pandemic influenza
plan to address the H1N1 pandemic?
Answer. Response was not received at the time of publication.
Question 2. What specific lessons were learned by New York City in
addressing the H1N1 cases at Rikers Island and to protect those that
may have come into contact with these patients?
Answer. Response was not received at the time of publication.
Question 3. What guidance was developed and distributed by New York
City for how to deal with H1N1 in institutional settings?
Answer. Response was not received at the time of publication.
Question 4. How is the New York City Department of Health and
Mental Hygiene working with the New York State Department of Health to
respond to the H1N1 outbreaks/pandemic?
Answer. Response was not received at the time of publication.
|
NEWSLETTER
|
|
Join the GlobalSecurity.org mailing list
|
|
|
