http://www.house.gov/reform/ns/107th_testimony/testimony_of_jerome_m.htm
Testimony Of Jerome M. Hauer
Before the House Subcommittee on Government Operations
Mr. Chairman and members of the committee, thank you for inviting me here today to testify before you about the recent Dark Winter exercise. Dark Winter was designed to challenge a group of people with extensive backgrounds in the highest level of government with a series of issues that the United States would face in the event of an intentional use of smallpox as a biological weapon on domestic soil. The scenario was designed to force those people playing the roles of cabinet members to make decisions we hope we will never confront, but which are all too likely because this country so woefully unprepared to deal with bioterrrorism.
At the outset I must say that while at this point in time our readiness posture is nowhere near where it should be, Secretary Tommy Thompson has made this issue a priority for the agency and has tasked his new Special Assistant with moving these programs forward at an accelerated rate. One of the highest priorities for the Special Assistant will be to address the types of issues that emerged from Dark Winter.
As I mentioned, Dark Winter had a set of specific learning objectives. I believe that the exercise achieved these objectives. There were a number of issues that we struggled with during the exercise that should be mentioned here today, including the recognition of an event, deploying the modest stockpile of smallpox vaccine that currently exists in the United States, determining how to use military assets and in what capacity these assets should be used, managing communication with the public during the crisis, ferreting out the issues of legal authority pertaining to state versus federal government rights regarding quarantine, shutting airports and interstate roads and generally restricting travel, and augmenting medical care at the local level when hospitals are overwhelmed.
A biological attack involving a contagious agent poses daunting challenges. Most state and local governments have not begun to address the issues that Dark Winter presented. Much of the focus of the Domestic Preparedness Program has been on chemical terrorism because these are tangible events that are easily recognized and can be managed much the same as a hazardous materials incident. An incident using biological agents will likely go unnoticed for days, and the typical response of first responders will have little impact. It is not a “lights and sirens” type of incident.
Recognition - Recognizing that an incident has occurred as early as possible affords us more time to mobilize the resources necessary to treat the sick and further limit the spread of disease. Recognition involves training primary care providers to include diseases such as smallpox and anthrax, diseases that they likely have never seen, in their differential diagnosis. This training has been difficult as most primary care providers have competing demand for their time and studying an issue they are likely never to deal with is not high on their list of priorities.
The second component of recognition is reporting. When one of these diseases is suspected, it is critical that the primary care provider knows who to report it to (almost always the local department of health), and that the department of health is prepared to respond to such a notification. Most health departments are not staffed for this and do not have systems in place to deal with evolving emergencies such as this.
The third component of recognition is surveillance. Systems must be in place to pick up unusual patterns of disease as early as possible. The Centers for Disease Control has been working with state and local health departments to develop these surveillance systems but it will be some time before automated systems are in place and linked to statewide and a national system. There is debate about the value of these systems in recognizing an evolving crisis as a result of a bioterrorist event. Dark Winter demonstrated that the earlier the disease is recognized and reported, the sooner response plans can be implemented.
Smallpox Vaccine Stockpiles - The two most important strategies for managing an outbreak of smallpox are containment and vaccination. Early on in Dark Winter, it became clear that we did not have enough smallpox vaccine to manage much beyond the early stages of the incident. Decisions had to be made about vaccinating health care providers, National Guard units in the affected area and those responding to assist, local emergency responders and their families, government officials, and troops to be deployed overseas. Emergency procurement and manufacturing of vaccine presented it’s own set of challenges, particularly when issues of the safety of the vaccine were presented.
With vaccine rapidly running out, containment became the challenge. Clearly isolation of patients with the disease was necessary. However, with thousands of patients, decisions had to be made about whether to isolate patients at home or in facilities through out the city. Questions arose about whether people would comply with isolation requests and what enforcement would be necessary. Then the issue of quarantine emerged, and significant discussion ensued, centering on who has the legal authority to impose quarantine and how it would be enforced. This led us to the issue of the role of the military in such an event.
Infrastructure/Quarantine - The difficulties in managing of one of these incidents was reflected in trying to maintain a city’s infrastructure were a quarantine to be enforced. If we tell people that they must remain in their house or within a certain area of the city, we then have an obligation to support those people. In an environment where local and state responders are already taxed to the limit, how do you integrate Federal assets into the local response? Furthermore, are adequate Federal assets available to provide to cities and states?
Enforcement - Naturally the National Guard would support the Governor’s efforts, but what role would active duty and reserve forces play? How would they be used to enforce quarantine and what level of force would they use? Should Guard forces be federalized and if so, what would their role then be?
The debate surrounding many of these questions was long and sometimes heated but it highlighted a fundamental issue; clearly we have work to do to prepare all levels of government to manage an incident of this nature.
The Media - Finally, Dark Winter demonstrated that we have not done enough to bring the media into our planning efforts for these events. Under the guise of security, we have treated the media as though they were irresponsible and could not be part of the planning. My experience in New York City shows just the opposite. The media will play a critical role in relaying information to the public. Ensuring that the media have an understanding of the difficult issues that government will face during an event like this will assist in the process rather than hurt it.
While there will always be a reporter who takes advantage of the event for their own benefit, we can say the same of government officials who use events like this to enhance their political stature. In both cases the effort usually backfires. We must develop a working relationship with the media and understand how and what to communicate to the public during an incident. We must also work with the media and with psychologists who have studied crowd behavior in order to learn how to avoid creating panic during what will be extremely tense times.
In summary, I think it is clear that Dark Winter demonstrated how unprepared the nation is to manage an act of bioterrorism involving a contagious agent like smallpox. Several areas require attention, including the following:
- Addressing the issue of legal authorities for enforcing isolation and quarantine as well as the use of military assets to assist in this process.
- Defining the legal authorities for limiting movement of the people from one city or state to another as well as limiting ingress and egress by air.
- Addressing communications with the media and the public. While work has begun on this issue, further attention is required.
- Addressing the issue of communities and their ability to provide medical care during a terrorist event. We must better define how we plan to augment local medical care with federal medical assets. Two questions need to be answered now: Where are these assets going to come from? And how long will it take to get them in place?
- Assisting state and local governments with massive logistical support.
- Managing the psychological aspects of an incident of this nature, including incident-related stress affecting those involved in the incident.
I believe one final point needs to be addressed and that is the concern by some that much of the effort going into preparing the nation to manage one of these events is based on hysteria. I think that near turn the greatest threat is still from bombs and guns but as time goes on the threat from biological agents will grow. That is not hysteria. Many of the programs need to address these events like the development of Smallpox Vaccine takes years. We need to use this time to get our nation ready. As the threat grows so must our resolve to have public health and medical infrastructure in place to recognize and manage an act of bioterrorism involving a contagious agent.
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