107th Congress

Funding for Bioterrorism Preparedness -- Hearing Before the Senate Appropriations Subcommittee on Labor, Health and Human Services, Education -- November 29, 2001

Members Present

Senators Tom Harkin (D-IA), Chairman; Arlen Specter (R-PA), Ranking Minority Member; Herb Kohl (D-WI); Mary Landrieu (D-LA); and Ted Stevens (R-AK).

Witnesses

Panel One: Jeffrey Koplan, M.D., M.P.H., Director, Center for Disease Control and Prevention (CDC); Anthony S. Fauci, M.D., Director, National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health (NIH)

Panel Two: Ken Alibek, M.D., President, Advanced Biosystems, Inc.; Joseph Barbera, M.D. Associate Professor and Co-Director, Institute for Crisis, Disaster, and Risk Management, The George Washington University; Joseph LeValley, Senior Vice President, Planning and Systems Development, Mercy Medical Center of Des Moines.

Summary

Purpose of Hearing: The purpose of the hearing was to focus on the resources required to improve the public health infrastructure and protect Americans from a possible biological weapons attack. The Chairman stated that the nation's public health system is not adequately prepared to either prevent or respond to a biological weapons attack. Senator Harkin noted that he and Senator Specter are finalizing legislation to be introduced based on the testimony from this hearing. Their intent would be to boost our nation's defenses against bioterrorism by putting the bulk of the funding, $1.3 billion, into improving public health departments, shoring up a local lab capacity, and expanding the health alert network. The proposal would also allocate an additional $200 million for research at NIH on new vaccines. The Committee wanted to hear from the witnesses about the level of funding they thought would be needed.

Overall Summary: The hearing was uneventful other than the anticipated question from Senator Specter to Dr. Koplan and Dr. Fauci about additional funding needs to combat bioterrorism. Senator Specter noted that he and Senators Harkin and Robert C. Byrd (D-WV) plan to introduce an amendment to the U.S. Department of Defense appropriations bill to add money to the U.S. Department of Health and Human Services (DHHS) for bioterrorism. He asked Dr. Koplan, in his professional judgment, what is needed now to address the needs. Dr. Koplan, and later Dr. Fauci, prefaced his response noting that his answers did not reflect the constraint that the White House had in determining priorities. Dr. Koplan provided the following:

• funds for state and local health departments at $15 to 20 million per state ($1.05 billion)
• upgrade for CDC facilities and labs ($150 million)
• National Pharmaceutical Stockpile ($640 million) and an additional $600 to 700 million for states to deploy the smallpox vaccine that DHHS has just contracted to purchase
• $96 million for increased security at the four CDC campuses
• $50 million for locality use.

Dr. Fauci responded that, "we could adequately spend up to $200 million for vaccine research and other bioterrorism research needs."

Opening Statements: Dr. Koplan and Dr. Fauci generally discussed ongoing efforts in bioterrorism at their respective Agencies. Dr. Fauci discussed NIH's role in this effort as the overall addressing of the biomedical research component of the counter bioterrorism movement. NIH does that with basic research to develop and apply the basic research to the production of diagnostics, therapeutics, and, ultimately, vaccines. With regard to smallpox, NIAID has embarked on dilutional studies to look at the already owned stock that the Federal Government has under the auspices of the CDC-15 million doses-to determine if the potency can be preserved by diluting them one-to-five or one-to-ten. NIH research also includes the third generation vaccines, namely the molecular biological approach, of looking at purified subunits that would obviate the concern regarding toxicities of using a live virus. Moving onto anthrax, the NIH's role is to cooperate with sister agencies, CDC, U.S. Army Medical Research Institute for Infectious Diseases, together with the Food and Drug Administration and others to develop a protective antigen anthrax vaccine to be used as a second and third generation. NIH is sequencing the full genomes of pathogenic microbes, including smallpox, anthrax, and several others in order to provide a very specific target for the development of diagnostics, therapeutics, and vaccines.

Dr. Koplan described CDC's use of appropriated funds to begin the process of improving the expertise, facilities and procedures at state and local health departments and then within CDC itself, related to bioterrorism. CDC has established a bioterrorism preparedness and response program to direct and coordinate its efforts. Since September 11, CDC has sent over 500 CDC staff to the field. CDC has also been working with many of the states to launch an effort to improve health laboratories across the country in a network.

Dr. Alibek urged the collection of intelligence on what pathogens had been studied in the Soviet Union, noting that while current research is focusing on anthrax and smallpox, there are a number of biological agents that could be used as biological weapons.

Dr. Barbera noted the high cost of maintaining a readiness for emergency preparedness at local hospitals and urged that, in order to prepare for these things, attention should be paid to how hospitals are treated as part of the public safety function in the emergency response community. Dr. LeValley provided his perspective on how ready local hospitals are to respond to incidents of terrorism involving biological, chemical, or nuclear materials, and the costs to ramp up from small events to large events.

Questions

Senator Harkin:

To Dr. Fauci: How soon will we have enough small pox vaccines available for every person in America? Can you describe the Secretary's (of HHS) purchase agreement? What is the distribution plan?

To Dr. Koplan: Do we have to provide annual funding for upgrading local and state public health.

Senator Specter:

To Dr. Koplan and Dr. Fauci: "You professionals need to tell us what you need, and if we do not fund it, then it is our responsibility. So, I'm glad we're going to get the figures today; and we're talking about ways to include it in the budget, to make sure it does get done."

To Dr. Koplan: "I would like to have your professional judgment on what we need to appropriate now to meet all the bioterrorism threats?"

To Dr. Fauci: "...the same question was put to you. What are the needs for NIH to have adequate funding for bioterrorism? The question is how much do you need and can you put to use now?

Senator Stevens:

To Drs. Koplan and Fauci: "Do we know anything about anthrax spores? What do they do? What is their range? How far can they travel without some type of assistance, either by a carrier or by wind, etc.? Can they get into papers and files?

To Drs. Koplan and Fauci: "Could you give us a statement of how much you believe you need to pay out, not commit-pay out between now and May and between now and the end of September?

To Drs. Koplan and Fauci: "I am particularly concerned with the people we send in harm's way, our military. Is there a 'cocktail' that could provide broad spectrum protection for people against a series of substances? Do you know about this research and are either of you pursuing funding it? I have been specifically requested to allocate portions of the defense budget to that immediately."

To Dr. Koplan: "What Agency is responsible for determining when buildings that have been infected with anthrax are safe? (CDC said that the Environmental Protection Agency [EPA] should be responsible. EPA had previously told the Senator that CDC was responsible.)

Senator Kohl:

To Dr. Koplan: "would caregivers need to be immunized in advance of exposure? What is the proposal regarding immunization of caregivers? How long does it take to provide that immunization to an individual- a day, a week, a month? How soon will immunization begin? Do we intend to immunize in advance those several hundred thousand primary caregivers around the country? Are you prepared to recommend that this group be immunized in advance at this time - next week, or next month?"

Senator Landrieu:

To Dr. Koplan and Dr. Fauci: "Could you just describe for the Committee the link, or the relationship, or the communications, you are having with our military infrastructure?"

Prepared by Anne Houser/OD/OLPA, December 14, 2001