[House Hearing, 112 Congress]
[From the U.S. Government Publishing Office]
TAKING MEASURE OF COUNTERMEASURES,
PART 3: PROTECTING THE PROTECTORS
=======================================================================
HEARING
before the
SUBCOMMITTEE ON EMERGENCY
PREPAREDNESS, RESPONSE,
AND COMMUNICATIONS
of the
COMMITTEE ON HOMELAND SECURITY
HOUSE OF REPRESENTATIVES
ONE HUNDRED TWELFTH CONGRESS
SECOND SESSION
__________
APRIL 17, 2012
__________
Serial No. 112-82
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Printed for the use of the Committee on Homeland Security
[GRAPHIC] [TIFF OMITTED] TONGRESS.#13
Available via the World Wide Web: http://www.gpo.gov/fdsys/
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COMMITTEE ON HOMELAND SECURITY
Peter T. King, New York, Chairman
Lamar Smith, Texas Bennie G. Thompson, Mississippi
Daniel E. Lungren, California Loretta Sanchez, California
Mike Rogers, Alabama Sheila Jackson Lee, Texas
Michael T. McCaul, Texas Henry Cuellar, Texas
Gus M. Bilirakis, Florida Yvette D. Clarke, New York
Paul C. Broun, Georgia Laura Richardson, California
Candice S. Miller, Michigan Danny K. Davis, Illinois
Tim Walberg, Michigan Brian Higgins, New York
Chip Cravaack, Minnesota Cedric L. Richmond, Louisiana
Joe Walsh, Illinois Hansen Clarke, Michigan
Patrick Meehan, Pennsylvania William R. Keating, Massachusetts
Ben Quayle, Arizona Kathleen C. Hochul, New York
Scott Rigell, Virginia Janice Hahn, California
Billy Long, Missouri Ron Barber, Arizona
Jeff Duncan, South Carolina
Tom Marino, Pennsylvania
Blake Farenthold, Texas
Robert L. Turner, New York
Michael J. Russell, Staff Director/Chief Counsel
Kerry Ann Watkins, Senior Policy Director
Michael S. Twinchek, Chief Clerk
I. Lanier Avant, Minority Staff Director
------
SUBCOMMITTEE ON EMERGENCY PREPAREDNESS, RESPONSE, AND COMMUNICATIONS
Gus M. Bilirakis, Florida, Chairman
Scott Rigell, Virginia Laura Richardson, California
Tom Marino, Pennsylvania, Vice Hansen Clarke, Michigan
Chair Kathleen C. Hochul, New York
Blake Farenthold, Texas Bennie G. Thompson, Mississippi
Robert L. Turner, New York (Ex Officio)
Peter T. King, New York (Ex
Officio)
Kerry A. Kinirons, Staff Director
Natalie Nixon, Deputy Chief Clerk
Vacant, Minority Professional Staff Member
C O N T E N T S
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Page
STATEMENTS
The Honorable Gus M. Bilirakis, a Representative in Congress From
the State of Florida, and Chairman, Subcommittee on Emergency
Preparedness, Response, and Communications..................... 1
The Honorable Laura Richardson, a Representative in Congress From
the State of California, and Ranking Member, Subcommittee on
Emergency Preparedness, Response, and Communications........... 4
The Honorable Bennie G. Thompson, a Representative in Congress
From the State of Mississippi, and Ranking Member, Committee on
Homeland Security:
Prepared Statement............................................. 5
The Honorable Robert L. Turner, a Representative in Congress From
the State of New York:
Prepared Statement............................................. 5
WITNESSES
Panel I
Dr. James D. Polk, DO, MMM, Principal Deputy Assistant Secretary,
Office of Health Affairs, Department of Homeland Security:
Oral Statement................................................. 7
Prepared Statement............................................. 8
Mr. Edward J. Gabriel, MPA, EMT/P, CEM, CBCP, Principal Deputy
Assistant Secretary, Preparedness and Response, U.S. Department
of Health and Human Services:
Oral Statement................................................. 11
Prepared Statement............................................. 13
Panel II
Chief Al H. Gillespie, EFO, CFO, Mifiree, North Las Vegas Fire
Department, and President and Chairman of the Board,
International Association of Fire Chiefs:
Oral Statement................................................. 24
Prepared Statement............................................. 26
Mr. Bruce Lockwood, Deputy Director, Emergency Management, New
Hartford, Connecticut, and Second Vice President, USA Council,
International Association of Emergency Managers:
Oral Statement................................................. 28
Prepared Statement............................................. 31
Sheriff Chris Nocco, Pasco County Sheriff's Office:
Oral Statement................................................. 33
Prepared Statement............................................. 34
Mr. Manuel L. Peralta Jr., Director of Safety and Health,
National Association of Letter Carriers:
Oral Statement................................................. 36
Prepared Statement............................................. 38
FOR THE RECORD
The Honorable Gus M. Bilirakis, a Representative in Congress From
the State of Florida, and Chairman, Subcommittee on Emergency
Preparedness, Response, and Communications:
Statement of the National Sheriffs' Association................ 2
APPENDIX
Questions Submitted by Chairman Gus M. Bilirakis for James D.
Polk........................................................... 49
Questions Submitted by Chairman Gus M. Bilirakis for Edward J.
Gabriel........................................................ 50
Questions Submitted by Ranking Member Laura Richardson for Edward
J. Gabriel..................................................... 50
TAKING MEASURE OF COUNTERMEASURES, PART 3: PROTECTING THE PROTECTORS
----------
Tuesday, April 17, 2012
U.S. House of Representatives,
Subcommittee on Emergency Preparedness, Response,
and Communications,
Committee on Homeland Security,
Washington, DC.
The subcommittee met, pursuant to call, at 2:03 p.m., in
Room 311, Cannon House Office Building, Hon. Gus M. Bilirakis
[Chairman of the subcommittee] presiding.
Present: Representatives Bilirakis, Turner, and Richardson.
Mr. Bilirakis. The Subcommittee on Emergency Preparedness,
Response, and Communications will come to order.
The subcommittee is meeting today to receive testimony on
efforts to ensure the protection of emergency response
providers in the event of a chemical, biological, radiological,
or nuclear attack.
I now recognize myself for an opening statement.
This hearing is the third in a series held by the
subcommittee on the vital issue of medical countermeasures. The
subcommittee has received testimony on challenges in the
research, development, and acquisition of medical
countermeasures and all plans and strategies to distribute and
dispense diagnostics, medications, and other life-saving
equipment.
Today we continue this discussion with a focus on how we
protect those who protect the public in the event of a
chemical, biological, radiological, or nuclear attack or
emergency.
As noted by the WMD commission, the threat of WMD terrorism
remains. The better we prepare, the more we reduce the risk. I
know everyone agrees. Medical countermeasures are but one
component that allows us to do so, and yet they are such a
critical piece of this that they deserve special attention as
far as I am concerned. It is a critical piece of the puzzle.
As we learned at our last hearing, there are a number of
dispensing methods under consideration. We have two
distinguished panels of witnesses here today to help us further
assess these plans and strategies at the Federal, State, and
local levels and to discuss how best to protect emergency
response providers and their families through mechanisms such
as voluntary pre-event vaccination and the predeployment of med
kits.
The provision of such assets to targeted populations is not
without precedent. The United States Postal Service has a
program well underway in several cities to deliver medical
supplies to the public in the event of a biological emergency.
As a condition of participation, the Postal Service required
that the letter carriers themselves and their families be
provided with antibiotic med kits in advance in order to ensure
their own protection. Kits and a program were then developed
with the FDA backing, of course, to achieve this.
Yet the law enforcement members that will escort the letter
carriers from home to home do not yet have the same option. The
assistant secretary for preparedness and response at HHS is
working with the FDA to rectify this, and I look forward to
hearing from Mr. Gabriel on the progress toward this important
issue.
Another priority that we have heard from the first
responder community is its desire for access to anthrax
vaccine. Given the millions of doses in the National stockpile
that annually expire and are then discarded, it would seem
entirely reasonable to make these supplies available to first
responders prior to their expiration. That would benefit, of
course, the responders who respond frequently to white powder
incidents that may some day turn out to be the real thing, and
it would certainly work for those of us who do not want to see
Federal resources wasted.
I look forward to hearing from Dr. Polk and from our second
panel how the pilot is proceeding and what needs to happen to
make it successful. I also think that we should look beyond the
anthrax threat and have a frank discussion about what other
measures, if any, should be taken with regard to other
biological, chemical, and radiological threats. It is in all of
our interests to ensure that our protectors are protected and
that their families are protected and that they are able to
come to work and do their jobs when duty calls. That will keep
us all safer and more secure.
Our previous hearings in this series have highlighted the
challenges we face in developing countermeasures and getting
them to the people who need them. First and foremost in our
minds should be our first responders, and I look forward to
discussing this with all of you today, how we can make this
endeavor a success.
Before I recognize our Ranking Member, I ask unanimous
consent to enter a statement from the National Sheriffs'
Association into the record. Without objection, so ordered.
[The information follows:]
Statement of the National Sheriffs' Association
April 11, 2012
Dear Chairman Bilirakis and Ranking Member Richardson: I would like
to thank you for allowing the National Sheriffs' Association (NSA) to
submit a statement for the record for the House Subcommittee on
Emergency Preparedness, Response, and Communications Hearing on
``Taking Measure of Countermeasures (Part 3): Protecting the
Protectors,'' held on April 17, 2012.
The National Sheriffs' Association (NSA) is one of the largest
associations of law enforcement professionals in the United States,
representing more than 3,000 elected sheriffs across the Nation, and a
total membership of more than 20,000. NSA is a non-profit organization
dedicated to raising the level of professionalism among sheriffs, their
deputies, and others in the field of criminal justice and public
safety.
The NSA and its members are pleased that your committee continues
to place a priority on protecting emergency services personnel. By
protecting the protectors, we believe the Nation is and will remain
more resilient in the face of natural catastrophes or intentional
attacks on our communities. Further, we note that, in the case of a
bioterrorism incident such as a wide-area anthrax attack, the
responders' household members will need protection as well. Research
shows the inclusion of the protection of family members as a key
component in the willingness of responders to report for duty in
biological incidents. As responders put their lives on the line for
their community, they deserve to have peace of mind from knowing that
protective antibiotics are immediately available to their household
members as well as themselves.
Since the May 12, 2011 hearing of your subcommittee, we can report
or cite little progress toward the goal of an adequately protected
workforce. The priorities highlighted in the testimony provided by
Chief Tan on behalf of the Emergency Services Coalition for Medical
Preparedness (NSA is a founding member) remains unaddressed, and is as
germane today as 11 months ago.
Emergency services personnel will be among the first exposed in an
event, and will have the greatest need for timely access to appropriate
medical countermeasures. The time is right to provide emergency
services personnel caches of pre-positioned personal and institutional
medical countermeasures. The existing processes developed since 2004 to
distribute med kits to postal workers could be extended to include the
protection of our fire service, law enforcement, emergency medical
services, public works, and other components of our emergency services
sector critical infrastructure.
We augment this statement only to make explicit that the
prepositioned med kits in the homes and workplaces of postal workers
participating in the National Postal Model cover their entire
households. Thus, knowing that their household members already have
protective antibiotics in hand if they should be needed, the postal
workers are poised to deliver medical countermeasures to every
residence in targeted areas in 1 day as soon as supplies arrive from
the Strategic National Stockpile.
On March 27 this year, your subcommittee convened to hear the
budget request from the DHS Office of Health Affairs (OHA). Assistant
Secretary Garza described the OHA's Medical Countermeasures (MCM)
Initiative. This initiative provides 100% of DHS personnel with
immediate access to life-saving antibiotic medications in the event of
a biological attack to ensure front-line operations can perform their
duty to save American lives. Their proposed budget request was to
extend this initiative to cover an additional 350 field locations.
On April 2, 2012 the Food and Drug Administration (FDA) held an
advisory panel on the issue of defining a pathway for FDA approval of
med kits. No first responder agencies were invited to testify, despite
our continued interest in this issue and well-known policy position. In
contrast, numerous public health and medical associations were invited
to provide testimony, despite having no stated policy position on these
issues.
The emergency preparedness system in this country is essentially
local, with mutual aid support from State and Federal authorities. To
leave our local emergency services personnel and their families
unprotected is to invite additional difficulties in responding to
large-scale biological events. In light of the proposed DHS
initiatives, it creates a disparity of the ``haves'' and ``have-nots.''
As you know, DHS will not be the first responders to communities in
need. The true responders will be the sheriffs and their deputies in
communities across the country that the National Sheriffs' Association
is proud to represent. We fully support what Dr. Garza advocates for
DHS and desire to have those same protections given to local
responders, including the deputies and their families. These
individuals will be the first on the scene, the first in danger, and
the first to make the decision to leave their families and stand in
harm's way. They must be minimally provided the same opportunity for
protection as DHS employees.
We support the November 2011 Institute of Medicine (IOM) report
that recommends against issuing med kits to all U.S. households in
favor of an approach of issuing med kits to specific populations, where
there is sufficient education, control, and programmatic oversight. The
emergency services agencies and personnel are that specific population;
we are entrusted by our citizenry to carry guns, work with hazardous
materials in life-threatening situations, and enter areas unsure of the
potential for harm. We are sworn to uphold the law and if necessary
give our lives performing that duty, but currently cannot be entrusted
to have a supply of potentially life-saving antibiotics on hand for
ourselves and our other household members to permit us to respond when
we will be most needed.
The NSA urges you to support the creation of a commercial med kit
to be used by the first responder community and their households and
continue to support the provision of a voluntary anthrax immunization
program for all emergency services personnel.
Thank you for your consideration of this matter.
Mr. Bilirakis. I now recognize the Ranking Member, Ms.
Richardson from California, for any statement that she may want
to make.
Thank you.
Ms. Richardson. Good afternoon.
I first want to start off by thanking our witnesses for
being here today and for your service on behalf of this
country, especially our first responders in our second panel.
We thank you as well.
I am particularly encouraged with Mr. Gabriel, with his
background of being a first responder. I think the
administration did a great job of getting good people in the
right positions. So we look forward to working with you.
Traditionally, when we think of first responders, we tend
to think of public safety, police, and fire. They are always
the ones that are there. But today we are expanding that
definition and I think getting a sense of the other individuals
who support our first responders on a regular basis.
Since 2004, the United States Postal Service has worked
with the Department of Homeland Security and the Department of
Health and Human Services to develop a system to augment the
point of distribution network to facilitate a rapid
distribution of countermeasures after a biological attack.
In 2005, the Centers for Disease Control recognized that if
a major biological event were to overwhelm local response,
invoking our letter carriers in the process would be critical
to saving lives. The critical role the United States Postal
Service can play in distributing medical countermeasures was
recognized by President Obama in Executive Order 13527, which
directed the Federal Government to develop a National U.S.
Postal Service medical countermeasures dispensing model to
respond to a large-scale biological attack. Today the resulting
National postal model is in operation in St. Paul-Minneapolis,
and we look forward to hearing about your success as well as
the new program to be launched in Louisville, Kentucky.
The program's success can be attributed to the patriotism
of postal workers and the careful planning on behalf of HHS,
DHS, and the Postal Service and many other Federal, State, and
local partners who have worked together to ensure that the
postal employees who participated in this program and their
families have access to prepositioned medical countermeasures.
Now when we look at this issue in these very tough fiscal
times, I find it ironic that we are having a discussion about
including other folks in our first responder model,
particularly our letter carriers and postal workers, when we
are just over on the Senate side having a discussion about
whether we are going to maintain 6 days a week service and keep
postal offices open. So it seems kind of ironic, here we are
talking about giving more responsibility and utilizing a
resource that we know is needed, yet in the same vein, we are
talking about cutting it and could very well eliminate our
ability to use this program.
Therefore, I urge in the testimony a real frank discussion
about the potential impacts of this program and whether, if
some of the proposed changes are brought to fruition, do we
really think that they would be met in light of some of the
potential cuts that are being proposed? I question if, in fact,
that can happen.
Further, some of my concerns are, is that there has been a
delay in issuing the guidance, and we look forward to getting
some feedback on when that can be expected.
Then finally, with this committee, I am hoping that we will
in fact bring to markup H.R. 2356, which was pulled, the WMD
Prevention and Preparedness Act of 2011, which would have a
great impact on medical countermeasures for first responders.
With that, I thank all of you, both panels, Nos. 1 and 2,
for your willingness to testify and the information that you
will share with us to make better decisions on behalf of the
American public.
With that, Mr. Chairman, I yield back the balance of my
time.
Mr. Bilirakis. Thank you.
Other Members of the subcommittee are reminded that opening
statements may be submitted for the record.
[The statements of Ranking Member Thompson and Mr. Turner
follow:]
Statement of Ranking Member Bennie G. Thompson
April 17, 2012
Good afternoon. I want to thank Chairman Bilirakis for holding this
hearing.
Adequately trained and equipped first responders are the foundation
of our response plans.
We cannot afford to miss opportunities to provide first responders
the tools they need to protect the public.
For 26 years, I served as a volunteer firefighter.
When we were called to action, we responded.
When first responders across this country are called to action,
they know that inaction or delay can cost lives. They have to act.
DHS needs to adopt a first responder mindset.
In 2008, the Homeland Security Council directed DHS to develop
guidance on the appropriate measures for first responders to take
following an anthrax attack.
Draft guidance was released in 2009. The final guidance has yet to
be issued.
Earlier this year, the full committee was scheduled to mark up H.R.
2356, the ``WMD Prevention and Preparedness Act of 2011.''
That legislation, introduced by a former Member of this committee,
Congressman Pascrell, would have directed the Department of Health and
Human Services to make surplus vaccines and countermeasures with a
short shelf-life available to first responders.
The same legislation would have reauthorized the Metropolitan
Medical Response System, which permits local governments to use grant
funding to buy countermeasures to protect first responders and their
families.
Unfortunately, the Majority cancelled mark-up of this vital
legislation.
I hope that today's hearing can be used to gain additional
information on the importance of this legislation and help this
committee move toward full committee consideration of H.R. 2356.
I look forward to hearing from the witnesses and I yield back the
balance of my time.
______
Statement of Hon. Robert L. Turner
April 17, 2012
Chairman Bilirakis, Ranking Member Richardson, and fellow Members.
I would like to welcome the witnesses appearing before us this
afternoon.
To paraphrase the Roman poet Juvenal, we are gathered here today to
ask ``Who protects the protectors?'' First responders put their lives
on the line each day in the service of their fellow citizens. If there
is another attack on the U.S. homeland, they will be the first on the
scene and the ones most at risk.
We know that the more we prepare, the lower their risk will be.
Medical countermeasures are an important element of our overall
emergency preparedness--for we cannot ask men and women to stand in
harm's way without taking the proper precautions to ensure their
safety.
We must also recognize that first responders perform best when they
know their families are safe. The pre-staging of medical
countermeasures in the homes of first responders for use by all family
members will ensure their peace of mind and allow them to turn their
attention to the pressing tasks at hand. I am heartened by evidence
that supplies can be safely stored in homes without risk of tampering
or improper use. Studies demonstrating a 97% compliance rate evidence
the dedication and training of these professionals.
Voluntary anthrax immunizations from expiring stockpiles of the
Strategic National Stockpile are another innovative use of Government
resources. The distribution of vaccines to first responders 6 months
before expiration avoids waste and maximizes the number of emergency
workers who are pre-immunized.
Finally, it is important to look beyond the anthrax threat to other
biological, chemical, and nuclear dangers. It is not enough to develop
countermeasures--for we must also ensure their proper and effective
distribution. The delivery of emergency medicine via the U.S. Postal
Service (the ``Postal Model'') does show promise. There are, however,
questions that must be addressed before we can be entirely satisfied
with this solution.
I look forward to hearing from the witnesses today, and yield back
the balance of my time.
Mr. Bilirakis. I am pleased to welcome now our first panel
of witnesses. Our first witness is Dr. J.D. Polk. Dr. Polk is
the principal deputy assistant secretary for health affairs and
deputy chief medical officer of the Department of Homeland
Security, a position he has held since November 2011.
Prior to joining DHS, Dr. Polk served as the deputy chief
medical officer and chief of space medicine at NASA's Johnson
Space Center. He also served as assistant professor at the
Departments of Preventive Medicine and Emergency Medicine at
the University of Texas Medical Branch. Dr. Polk received his
degree in osteopathic medicine from A.T. Still University in
Clarksville, Missouri. He holds a masters of science in space
studies with a concentration in human factors from the American
Medical Military University and a masters in medical management
from Southern California's Marshall School of Business.
Following Dr. Polk, we will receive testimony from Edward
Gabriel. Mr. Gabriel is the principal deputy assistant
secretary for preparedness and response at the Department of
Health and Human Services.
Prior to joining ASPR, Mr. Gabriel served as the director
of global crisis management and business continuity for the
Walt Disney Company. Mr. Gabriel previously served as a
paramedic in the New York City Fire Department's Emergency
Medical Service and was assigned to the New York City Office of
Emergency Management as a deputy commissioner for planning and
preparedness.
Mr. Gabriel earned his bachelor's degree from the College
of New Rochelle and his masters in public administration from
Rutgers University.
Welcome, sir.
Your entire written statements will be entered into the
record. I ask that you each summarize your testimony for 5
minutes.
We will start with Dr. Polk.
Thank you. You are recognized, Doctor.
STATEMENT OF JAMES D. POLK, DO, MMM, PRINCIPAL DEPUTY ASSISTANT
SECRETARY, OFFICE OF HEALTH AFFAIRS, DEPARTMENT OF HOMELAND
SECURITY
Dr. Polk. Thank you Chairman Bilirakis, Ranking Member
Richardson, Congressman Turner, and distinguished Members of
the committee. It is an honor to testify before you today and
alongside my colleague from ASPR, Mr. Ed Gabriel, on the
Department of Homeland Security's efforts regarding medical
countermeasures for first responders.
These issues are particularly important to both Mr. Gabriel
and myself as we have started out our careers as first
responders. This committee is very familiar with the Office of
Health Affairs' role and responsibilities. OHA provides health
and medical expertise in support of the DHS mission to prepare
for, respond to, and recover from all threats. We are the
principal medical and health authority for DHS and the
legislative coordinator for biodefense within the Department.
Today I will discuss a few medical countermeasures and
first responder initiatives currently under way by the
Department and in concert with our interagency partners. The
unremitting threat of an anthrax attack using biological agents
requires that we continue to remain vigilant. A wide-area
attack using aerosolized Bacillus anthracis is one of the most
serious biological threats facing the United States. A
successful anthrax attack could potentially encompass hundreds
of square miles, expose hundreds of thousands of individuals,
cause illness, death, fear, societal disruption, and
significant economic damage.
If untreated, the disease is nearly 100 percent fatal.
Those exposed must receive life-saving medical countermeasures
as soon as possible following their exposure. There is no
indication of a specific credible anthrax attack against the
United States at this time. However, due to the risks and
consequences associated with such an event, it is a priority of
the Federal Government and DHS to ensure the readiness of the
Nation's first responders and Federal, State, local, Tribal,
and territorial governments to enhance their capacity to
respond to a biological attack.
The mission of DHS includes enhancing response capabilities
at the State and local levels. Communities stand to benefit if
they have prevaccinated responders able to deploy immediately.
DHS, in partnership with CDC, is codeveloping a concept for a
pilot project that would provide expiring anthrax vaccines to
responders, as you mentioned, as they would have an increased
chance of exposure reflective to their response function.
Responders would decide on an individual basis whether or not
to be vaccinated.
Understanding that all events are local, we work directly
with State and local public health emergency response, law
enforcement, emergency management, and emergency medical
services leaders to develop response capabilities for health
security threats, including biological threats. For example,
OHA together with FEMA conducted a series of anthrax response
exercises at each of the 10 FEMA regions designed to help
coordinate roles, responsibilities, and critical response
actions following a wide-area anthrax attack.
In 2009, OHA requested comments from the public and
interested stakeholders on draft guidance developed through an
interagency process for appropriate protective measures for
responders in the immediate post-attack environment of an
aerosolized anthrax attack. Since then both DHS and HHS' Office
of the Assistant Secretary of Preparedness and Response have
worked diligently together to develop consensus guidance. The
guidance will reflect the most current understanding and
evidence-based medicine for protective countermeasures after a
wide-area anthrax attack.
Finally, all of these efforts combined with our Biowatch
and our National Biosurveillance Integration Center, or NBIC,
form a contiguous biosurveillance and situational awareness
system that serves to enhance the ability of local responders
to be alerted to and respond quickly to biological attacks. DHS
has developed and will continue to refine integrated
multidisciplinary detection and biosurveillance capabilities to
provide the Federal Government and State and local partners
with the tools necessary to respond to unfolding biological
events.
In conclusion, thank you again for the opportunity to
testify today. The Department of Homeland Security values the
work of the Nation's first responders and will continue to
support them in their critical preparedness and response
efforts. I look forward to any questions that you may have.
[The statement of Dr. Polk follows:]
Prepared Statement of James D. Polk
April 17, 2012
Good afternoon, Chairman Bilirakis, Ranking Member Richardson, and
distinguished Members of the subcommittee. It is an honor to testify
before you today on the Department of Homeland Security's (DHS) efforts
regarding medical countermeasures (MCM) for first responders.
As you are aware, the Office of Health Affairs (OHA) provides
health and medical expertise in support of the DHS mission to prepare
for, respond to, and recover from all threats and hazards. OHA's
responsibilities include: Serving as the principal advisor to the
Secretary and the Federal Emergency Management Agency (FEMA)
Administrator on medical and public health issues; leading and
coordinating biological and chemical defense activities; providing
medical and scientific expertise to support DHS preparedness and
response efforts; and leading the Department's workforce health and
medical oversight activities. OHA also serves as the primary DHS point
of contact for State, local, Tribal, and territorial governments on
medical and public health issues.
OHA has four strategic goals that coincide with the strategic goals
of the Department:
1. Provide expert health and medical advice to DHS leadership;
2. Build National resilience against health incidents;
3. Enhance National and DHS medical first responder capabilities;
and
4. Protect the DHS workforce against health threats.
Today I will discuss a number of MCM and first responder
initiatives that support our strategic goals.
executive order 13527: establishing federal capability for the timely
provision of medical countermeasures following a biological attack
Executive Order (E.O.) 13527 seeks to mitigate illness and prevent
death, sustain critical infrastructure, and complement State, local,
Tribal, and territorial government MCM distribution capacity. The
threat of an attack using a biological agent is real and requires that
we remain vigilant. A wide-area attack using aerosolized Bacillus
anthracis, the bacteria that causes anthrax, is one of the most serious
mass casualty biological threats facing the United States. A successful
anthrax attack could potentially encompass hundreds of square miles,
expose hundreds of thousands of people, and cause illness, death, fear,
societal disruption, and significant economic damage. If untreated, the
disease is nearly 100 percent fatal; those exposed must receive life-
saving MCM as soon as possible following exposure.
In particular, Section 4 of the E.O. directs Federal agencies to
establish mechanisms for the provision of MCM to personnel to ensure
that the mission-essential functions of the Executive Branch
departments and agencies continue to be performed following a
biological attack. Due to the nature of the DHS mission, a significant
portion of our workforce performs mission-essential functions, and
others could be exposed during daily activities. As a result, Secretary
Napolitano directed DHS to develop a plan and seek funding for a
capacity to provide emergency antibiotics to all DHS employees in an
attacked area, not just those who are mission-essential. OHA leads this
effort for DHS and we are pleased to say that DHS is among the first
Federal agencies to have met this requirement of the Executive Order.
stockpiling and forward-caching of mcm
In the past year, OHA successfully introduced an MCM strategy to
mitigate the impact of a biological attack on DHS personnel. As part of
this strategy, OHA implemented a plan to purchase and stockpile MCM for
all DHS employees, those in DHS care and custody, working animals, and
contractor employees with DHS badges. DHS identified regional cache
locations for every DHS Component in order to pre-position MCM across
the country for employees to have immediate access after a biological
incident.
In order to make the plan both cost-effective and protect even our
most remotely-located employees, OHA worked with the Centers for
Disease Control and Prevention (CDC) and the Food and Drug
Administration (FDA) to draft an Emergency Use Authorization (EUA) that
would permit, among other things, the stockpiling and distribution of
10-day courses of doxycycline at component caches and dispensing of the
medication by non-health care professionals. This EUA was issued by the
FDA Commissioner on July 21, 2011. OHA was then able to forward-cache
nearly 200,000 courses of MCM to 127 field locations for regional
stockpiling, in addition to centrally stockpiling additional MCM that
might need to be utilized following an incident. OHA continues to
partner with FDA to satisfy regulatory considerations for re-labeling
and forward-caching of MCM. In addition, pre-EUA submissions are in
place to support a possible EUA for ciprofloxacin, an antibiotic that
is also effective for post-exposure prophylaxis of inhalational
anthrax.
Until an EUA for ciprofloxacin is issued, DHS is restricted to
distributing this countermeasure in the currently approved 60-day
courses and through a traditional medical dispensing model utilizing
DHS health care providers, including the Department's more than 3,500
Emergency Medical Service Technicians (EMTs). However, provisions in
both House and Senate versions of the Pandemic and All-Hazards
Preparedness Act (PAHPA) reauthorization bill would, if enacted,
facilitate such pre-event and response activities.
In the event of a biological incident, it is important to remember
that all affected DHS personnel and their families will also have
access to MCM from the Strategic National Stockpile through existing
community points of dispensing (PODs).
advising dhs leadership on health and medical issues
Serving as the principal advisor to the Secretary and FEMA
Administrator on medical and public health issues has afforded OHA the
ability to ensure synergistic efforts in implementing a Department-wide
strategy for MCM. OHA provides guidance and comprehensive planning
information to DHS components through the Anthrax Operations Plan
Department Guidance Statement (DGS) in coordination with the Office of
Operations Coordination and Planning, develops and delivers training on
dispensing of the MCM, assists operational components in the
development of dispensing plans and conducts DHS points of dispensing
(POD) exercises. To supplement the DGS, OHA also provides medical
guidance for MCM storage, administration, and non-medical PODs, as well
as medical treatment for working and service animals exposed to anthrax
spores. We are now in the process of sharing lessons learned and
coordinating with the Federal interagency to ensure the consistency of
plans across the Federal Government, including our partners at the
Department of Health and Human Services (HHS), CDC, and the FDA.
Coordinated medical oversight provided by OHA ensures that the
Department's MCM program and medical treatment rendered pursuant to the
program is uniform and consistent to National standards. Currently, OHA
has a medical liaison officer (MLO) responsible for the provision of
medical guidance, support, and leadership at FEMA, which has proven to
be a very successful model. We are in the process of establishing MLOs
with Customs and Border Protection (CBP), the Transportation Security
Administration (TSA), and Immigration and Customs Enforcement (ICE) to
support their operational workforces. These Components will benefit
from coordinated and centralized medical programmatic direction and
guidance from OHA, along with an established protocols system that will
support and enhance steady-state and deployment readiness activities.
The Department as a whole will be better situated to prepare for and
respond to disasters and significant events through the increased depth
in medical leadership this structure provides.
response guidance for first responders
OHA also provides our State, local, Tribal, and territorial
partners with guidance for protection of personnel responding to a
wide-area anthrax attack. Through the Federal interagency process, OHA
and HHS's Office of the Assistant Secretary for Preparedness and
Response (ASPR) co-led the effort to develop consensus guidance
regarding appropriate protective measures for first responders in the
immediate post-attack environment of an aerosolized anthrax attack. The
guidance reflects the most current understanding of the unique
environment that would exist after a wide-area anthrax release. The
guidance is a prudent step to provide to first responders the best
information on protective measures currently available.
pre-event anthrax vaccination for responders
In July 2009, the CDC Advisory Committee on Immunization Practices
(ACIP) stated that by priming the immune system before exposure to
Bacillus anthracis spores, pre-event vaccination might provide more
protection than antimicrobial drugs alone to persons at risk for
occupational exposure. ACIP recommendations state that, ``Emergency and
other responders are not recommended to receive routine pre-event
anthrax vaccination because of the lack of a calculable risk
assessment. However, responder units engaged in response activities
that might lead to exposure to aerosolized B. anthracis spores may
offer their workers voluntary pre-event vaccination. The vaccination
program should be carried out under the direction of a comprehensive
occupational health and safety program and decisions for pre-event
vaccination should be made based on a calculated risk assessment.''
(Centers for Disease Control and Prevention, 2010)
``Responders'' refers to a diverse set of individuals who perform
critical services necessary to mitigate the potential impact of a wide-
area anthrax attack. These responders may either be in the area
identified as the point of initial release and/or are called in from
elsewhere to provide follow-on activities in a contaminated area
performing critical services. Our National response capability to a
wide-area anthrax attack would be enhanced by having pre-vaccinated
responders, able to deploy immediately and confident that they have
been afforded as much protective status as possible for these
activities. Pre-event vaccination of these responders will increase the
ability to save lives, maintain social order, and ensure continuity of
Government after a wide-area anthrax attack.
The CDC's Strategic National Stockpile (SNS) approached OHA in June
2011 with the idea of working collaboratively to determine a use for
anthrax vaccine with a short shelf life rather than disposing of the
unused vaccine. Anthrax vaccine is currently stockpiled in the CDC's
SNS to support State and local response during a widespread aerosolized
anthrax release. Based on DHS threat assessments and the Department's
prioritization of efforts for anthrax preparedness, voluntary pre-event
vaccination of responders is deemed to be an appropriate step to
prepare for this threat.
Therefore DHS and CDC SNS are developing a program for the
provision of expiring anthrax vaccine to Federal departments and
agencies, as well as State and local jurisdictions for the voluntary
pre-event vaccination of responders. Each Federal, State, local,
Tribal, or territorial program must meet eligibility requirements,
including the existence of a comprehensive occupational health and
safety program through which to manage a vaccination program for
anthrax vaccine. It is important to note that the Federal Government is
not establishing a Federal vaccination program for State and local
responders, but rather providing an existing resource to States and
localities who will implement the vaccination program within their
jurisdictions. No funding or other resources for any administrative
programmatic support requirements will be associated or available
through DHS or HHS outside of the provision of the physical vaccine.
Such a program would distribute anthrax vaccine to responders at
greatest risk of exposure and would not impact vaccines needed for
Department of Defense (DOD) personnel recommended to receive the
vaccine for general use prophylaxis.
As part of the program development process, CDC and OHA formed a
Federal interagency working group to discuss key decision points
regarding voluntary pre-event anthrax vaccination of responders. This
working group convened a series of meetings to discuss scientific
medical data and policy implications among subject matter expert
representatives from over twelve different Federal departments. The
group developed pre-event anthrax vaccine risk prioritization guidance
for use in the event that demand exceeded supply of vaccine. This
guidance identifies the categories of responders eligible to receive
pre-event anthrax vaccine, contingent on supply and current threat
assessment. All categories of responders identified in this guidance
are considered at sufficient risk of future exposure to anthrax to
warrant voluntary pre-event vaccination, should the supply be
sufficient at the time of the request.
The first step to initiate this pre-event anthrax vaccine
distribution program is to pilot the program on a small and manageable
scale to ensure the methodology supports responsible vaccine use and to
help the U.S. Government understand demand for the vaccine. The pilot
program will provide data to allow us to make changes to improve
program management and to help scale up the program, as needed, to
achieve a safe, reliable, functional, and sustainable capability to
widely distribute vaccine, within the constraints of existing program
capacity. The pilot will include two Federal departments or agencies
and two State or local jurisdictions (including Tribal and territorial
jurisdictions) interested in working with DHS OHA and CDC SNS to
deliver this program to a pilot cohort of responders. Those selected
will manage a voluntary anthrax vaccination program for a minimum of 18
months, in order to accommodate the full 5-dose priming series of
vaccine to the volunteer recipients.
conclusion
Thank you again for the opportunity to testify today. The
Department of Homeland Security values the work of the Nation's first
responders and we are always looking for ways to support them in their
critical preparedness and response efforts. I look forward to any
questions that you may have.
Mr. Bilirakis. Thank you, Dr. Polk.
Mr. Gabriel, you are recognized for 5 minutes.
STATEMENT OF EDWARD J. GABRIEL, MPA, EMT/P, CEM, CBCP,
PRINCIPAL DEPUTY ASSISTANT SECRETARY, PREPAREDNESS AND
RESPONSE, U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES
Mr. Gabriel. Good afternoon Chairman Bilirakis and Ranking
Member Richardson and Members of the subcommittee.
I am Edward Gabriel, the principal deputy assistant
secretary for preparedness and response at the United States
Department of Health and Human Services. Thank you for inviting
me here today on behalf of HHS to testify on protecting first
responders.
Before I describe HHS efforts to protect first responders,
I want to note that before joining ASPR 7 months ago, I spent
30 years as an emergency medical technician, paramedic, and
chief with the New York City fire department emergency medical
services. I was on ground prior to the collapse of the towers
on September 11 as a deputy commissioner of emergency
management and personally witnessed the heroism and sacrifices
of fellow first responders.
I understand the needs of first responders, and I truly
believe that we in the Federal Government are making a
difference in our Nation's preparedness and will continue to
improve the lives of those who are doing work on the ground
every single day.
As good stewards of our limited Federal resources, HHS and
our Federal partners are developing tools and strategies with
all-hazards adaptability for our first responders. One tool in
development is the med kit. The anthrax med kits would contain
antibiotic doxycycline along with instructions for appropriate
use in home. Med kits would be available in advance of an
emergency to particular groups, such as first responders and
families. While further research is needed to ensure med kits
can be safely stored and used in private homes, HHS is
optimistic about this capability and its implications for our
first responders' protection during a public health or medical
emergency.
The second tool in the development is the postal model. HHS
awarded the National postal model grants in specific cities and
jurisdictions throughout the country. These grants fund
planning and exercises to incorporate U.S. Postal Service's
employee volunteers into community plans to deliver
countermeasures after an anthrax bioterrorism attack.
Recently, HHS supported a tabletop exercise in Louisville,
Kentucky. Our primary focus of this exercise was to determine
the roles of law enforcement and postal workers in the delivery
of medical countermeasures under real-life circumstances. HHS
is planning another full-scale exercise in Minneapolis on May 5
to examine issues and implications for the delivery of
countermeasures to approximately 40,000 households in four zip
codes. Since this program began in 2010, we have captured
lessons learned from various exercises and have improved future
applications and planning guidance.
As we analyze these results, we will coordinate with our
partners and incorporate best practices into similar
applications. We are also developing a new and improved medical
countermeasures and personal protective equipment to protect
first responders in their communities. Since Project BioShield
was authorized in 2004, HHS has built a robust pipeline of
next-generation medical countermeasure products. We have funded
over 80 candidate products that, if successful, will have the
potential to transition to procurement contracts and inclusion
in the Strategic National Stockpile.
I would like to note that funding for Project BioShield
expires in 2013. You and your colleagues are working to
reauthorize the Pandemic All-Hazards Preparedness Act, which
includes the reauthorization of appropriations for Project
BioShield through 2018. The reauthorization of PAHPA supports
our work and will ensure we continue to have tools necessary to
respond.
Lastly, as my colleague from DHS mentioned, I would like to
note that we are in the final phases of completing guidance for
first responders following an anthrax attack. This is a
significant step in protecting first responders, and I look
forward to sharing more on this guidance in the near future.
In conclusion, all of our efforts come down to the same
goals: Building a resilient Nation and saving lives when
emergencies occur. This is true for all of us, whether at the
Federal, State, local, or private sector.
Before I came to ASPR, I was a director of global crisis
management and business continuity for the Walt Disney company.
My work required strong development of protective relationships
worldwide with law enforcement, emergency management,
intelligence services, as well as my private-sector
counterparts. Based on my experiences, I have learned that
meeting the needs of first responders before, during, and after
an event is critical. I look forwarded to working with you to
ensure that our progress continues and we, as a Nation, are
truly prepared.
I thank you for the opportunity to testify before you
today, and I would be happy to answer any questions you may
have.
[The statement of Mr. Gabriel follows:]
Prepared Statement of Edward J. Gabriel
April 17, 2012
Good afternoon Chairman Bilirakis, Ranking Member Richardson, and
Members of the subcommittee. I am Mr. Edward Gabriel, the principal
deputy assistant secretary for preparedness and response (ASPR) at the
U.S. Department of Health and Human Services (HHS). Thank you for
inviting me here today, on behalf of HHS, to testify on protecting
first responders.
Before I begin this afternoon, I want to mention that maintaining
and supporting our State and local response capability is of particular
personal significance to me. Before joining ASPR 6 months ago, I spent
30 years as a first responder. I began as an emergency medical
technician (EMT) then became a paramedic working throughout the city of
New York. I rose through the ranks to become a New York City Fire
Department Emergency Medical Services system assistant chief and
ultimately became the deputy commissioner for planning and preparedness
in New York City's Office of Emergency Management. I was on the ground
with other first responders prior to the collapse of the towers on
September 11, 2001 and personally witnessed the heroism and sacrifices
of our first responders. I have spent my career responding to
emergencies. I understand the needs of first responders and I truly
believe that what we in the Federal Government are doing is making a
difference in our Nation's preparedness and will continue to improve
the lives of those doing the work on the ground.
This afternoon I'm going to talk to you about the unique role that
HHS plays in protecting and supporting the Nation's first responder
community and helping them become more resilient after tragedy strikes.
Our strategic approach involves creating best practices for getting
medical countermeasures to first responders quickly in a range of
emergency situations; developing promising new products, tools, and
technologies to protect our first responders and giving them the tools
needed to be successful; and integrating behavioral health into overall
public health and medical preparedness, response, and recovery
planning. First responders are defined as a diverse set of individuals
(emergency medical services practitioners, firefighters, law
enforcement, and HAZMAT personnel, the emergency management community,
public health and medical professionals, skilled support personnel,
emergency service and critical infrastructure personnel, certain other
Government and private sector employees, and individual volunteers
assisting in response activities) who are critical to mitigating the
potential catastrophic effects of public health emergencies. I'll talk
about our new approaches to coordination where Federal, State, local,
Tribal, territorial, and private-sector partners comprise the ``medical
countermeasures enterprise'' and come together to collaborate and plan
the development and deployment of countermeasures. Our approach
throughout this enterprise takes the whole system into account--from
early research to deployment--and includes the needs of first
responders. I'll also focus on the first responder community not only
in the context of medical, fire, and police but also other critical
human services and how you and I, our families, and those in our
communities might also play critical roles in a first response. I hope
to leave you today with a clear picture of our work in this area and
our proactive strategies to continue progress. Our Nation's ability to
respond to an emergency depends on truly collective approaches and a
strong partnership with our State and local partners who have the
primary role in those first critical moments when the speed and
thoughtfulness of response translates into more lives saved.
Supporting and assisting our Nation's first responders is a top
Federal priority; however, we all recognize that the act of first
response occurs primarily at the State and local level. Therefore, we
focus attention on empowering States and communities to prepare for and
respond to emergencies as safely, effectively, and efficiently as
possible. As we are all aware, when disasters strike it is the response
from the local community during the minutes before and after the event
that saves lives. Our communities need to be resilient and be able to
respond quickly. Today, State and local communities are more resilient
than ever before. Incidents including the tornadoes that touched down
in Alabama and Missouri in 2011 and recent flooding in Louisiana
demonstrated how State and local communities are able to respond during
the initial stages of the public health emergency response with little
to no need for Federal assistance. HHS' Hospital Preparedness Program
(HPP) and Public Health Emergency Preparedness (PHEP) cooperative
agreement programs support State and local resilience by funding
preparedness activities and infrastructure at State and local public
health and medical facilities. A Hospital Preparedness Program report
entitled ``From Hospitals to Healthcare Coalitions: Transforming Health
Preparedness and Response in Our Communities,'' describes the
achievements of our State partners in building health care preparedness
across the Nation, and illustrates how States have used the
capabilities developed and funded through the program in both large and
small incidents. One specific accomplishment detailed in this report is
that more than 76 percent of hospitals participating in the HPP met 90
percent or more of all program measures for all-hazards preparedness in
2009. These activities promote community resilience and improve health
outcomes following emergencies and disasters.
Despite HPP and PHEP investments, the financial realities we are
all facing today continue to challenge our public health and medical
infrastructure and, ultimately, communities' ability to be resilient.
We are already witnessing a decline in the State and local public
health workforce as a result of these fiscal constraints.
As good stewards of Federal resources, we must focus on developing
tools and strategies for all-hazards which can be implemented in a
range of emergencies. If a chemical, biological, radiological, nuclear
(CBRN), or emerging infectious disease incident were to occur, we might
have a few minutes or hours, not days, to dispense medical
countermeasures to treat first responders and their communities,
depending on the nature, scope, and size of the event. We will need
first responders on the ground as soon as possible to treat the health
impacts of the event and maintain the safety and security of their
communities. In the aftermath of an event we will rely on multiple
modalities to protect first responders, including pre- and post-event
treatments. This treatment strategy is central to many of our
preparedness plans including those for anthrax, smallpox, influenza,
and other agents. For bacterial threats, antibiotics offer one of the
best courses of action as vaccines can take days, weeks, or months to
be effective unless provided to responders before-hand. For example,
the CDC's Advisory Committee on Immunization Practices recommends a
three-dose anthrax vaccination regimen, as a post-exposure prophylaxis,
for responders following an event, in addition to antibiotics. While
the first vaccine dose would be administered as soon as possible post-
exposure, the second and third doses would be administered 2 and 4
weeks later. The vaccine is not immediately effective and is not fully
protective until after that third dose. Antibiotics are an important
part of treatment strategies to bridge time gaps by maximizing
protection from vaccines post-exposure.
To provide a quick and effective response, first responders will
need to receive the most effective treatments quickly. I am pleased to
say that Federal partners are working better together to ensure that we
have the best tools available to treat and respond effectively to
public health and medical emergencies. Federal partners are
collaborating via the Public Health Emergency Medical Countermeasures
Enterprise (PHEMCE)--the overarching interagency convening body for
medical countermeasure development, stockpile, and use. ASPR leads the
PHEMCE, which brings together three primary HHS agencies--the National
Institutes of Health (NIH), the Centers for Disease Control and
Prevention (CDC), and the Food and Drug Administration (FDA)--along
with four key interagency partners--Department of Homeland Security
(DHS), Department of Defense (DoD), Department of Veterans Affairs
(VA), and Department of Agriculture (USDA). Working together full-time,
as an enterprise, we are coordinating, exchanging information, and
learning from each other daily to optimize preparedness and response
for public health emergencies. The PHEMCE is bringing together partners
not only to identify and support the development of a number of novel
medical countermeasures to protect first responders but to also
identify and plan for the use and distribution of acquired products.
Today, HHS and other Federal partners are working to develop new
tools with potential all-hazards adaptability to support and protect
first responders. While HHS does not lead first responder activities,
we do have a critical and unique role in advancing promising approaches
in response at the National level which can then translate into local
use. One such approach in the development and pre-approval phases is
the anthrax ``med kit.'' The anthrax med kits contain the antibiotic
doxycycline along with instructions for appropriate use in the home.
Upon approval, med kits would be available in advance of an emergency
to particular groups such as first responders and their families. These
med kits could be purchased directly, either by the first responders
themselves or their employers. While further research is needed to
ensure med kits can be safely stored in private homes without misuse,
we are optimistic about this capability and its implications for first
responder protection during a public health or medical emergency.
As you know, we have already seen success in the use of the med kit
concept through pilot testing the National U.S. Postal Service (USPS)
medical countermeasures dispensing program. Supporting implementation
of actions described in Executive Order 13527, Medical Countermeasures
Following a Biological Attack, HHS has invested $10 million since 2010
to support National Postal Model grants awarded to specific cities and
jurisdictions throughout the country. The grants fund planning and
exercises to incorporate USPS employee volunteers into community plans
to deliver medical countermeasures after an anthrax bioterrorism
attack. Under this model, volunteer USPS letter carriers receive pre-
event antibiotics via a Home Antibiotic kit that they store in their
homes; these are for themselves and household members. If a public
health or medical emergency requiring medical countermeasures occurred,
letter carriers and their household members would be instructed to
begin taking their antibiotics. This would allow these USPS volunteers
to perform their mission, as outlined in the National Postal Model, to
deliver antibiotics as prescribed by their specific postal plans. Law
enforcement officers accompany the letter carries as they deliver the
antibiotics to homes in predetermined ZIP codes. Since this program
began, we have learned lessons from the various exercises and have
improved future applications and planning guidance. Recently, HHS held
a table-top exercise in Louisville, KY. A primary focus was determining
the roles of law enforcement and postal workers in delivery of medical
countermeasures under ``real-life'' circumstances. HHS is planning
another full-scale exercise in Minneapolis on May 5 to examine issues
and implications for the delivery of countermeasures to approximately
40,000 households in four zip codes. As we analyze results, we will
coordinate with our partners and incorporate best practices into
similar applications.
As we work with our partner agencies to develop all-hazards tools
to support first responders, we must also develop policy documents to
guide efforts to protect first responders and their communities from an
anthrax attack and other emergencies. These interagency guidance
documents will provide clarity and improve coordination to ensure that
the needs of all responders are met before, during, and after an
emergency. It is critical that strategies are developed before an event
to ensure that the tools available for all responders are used to their
maximum capacity.
In addition to developing the policies themselves, there will be
implementation challenges, including monitoring recipients of pre-event
vaccinations, and in the aftermath of an event, the immediate
availability of adequate vaccine and the availability of resources to
support vaccination in the midst of an on-going event will need to be
addressed. These challenges span the regulatory authorities and
resources of several Federal agencies and departments, as well as those
of our State and local partners. HHS is actively engaging with
interagency partners to address these challenges and establish policies
for the distribution of medical countermeasures to first responders,
not just for anthrax, but for all potential hazards and threats. As
such, the resulting guidance documents will be considered ``living
documents'' in the sense that they will be refined as the evidence base
is strengthened for determining exposure risk and the efficacy of
protective measures and feedback is received from stakeholders. Even as
we update existing guidance and disseminate new guidance, we will look
forward to continuing dialogue with our stakeholders and partners in
the first responder community.
We've done considerable work in developing novel approaches to get
medical countermeasures to first responders quickly and coordinate at
all levels of government to ensure that our first line of defense is
protected in an emergency. However, we are also looking forward and
developing new and better medical countermeasures to both protect first
responders and the communities they live in, as well as improving their
tool kit to treat those affected. In August 2010, HHS Secretary
Sebelius released the Public Health Emergency Medical Countermeasures
Enterprise Review: Transforming the Enterprise to Meet Long-Range
National Needs (MCM Review). The MCM Review examined the steps involved
and made recommendations regarding the research, development, and
regulatory approval of medications, vaccines, and medical equipment and
supplies for a public health emergency. In implementing recommendations
of the MCM Review, HHS has already made progress in improving the
entire medical countermeasure pipeline--from early stage research and
development to distribution.
As I mentioned earlier in my testimony, the PHEMCE is bringing
together partners to identify and to support the development and
deployment of a number of novel medical countermeasures to protect
first responders. My office works closely with HHS partners including
NIH, CDC, and FDA to develop, procure, and stockpile medical
countermeasures for CBRN threats as well as emerging infectious
diseases, including pandemic influenza. We are now more prepared for a
broad range of threats and emerging infectious diseases than at any
point in our Nation's history. We have a robust pipeline of next-
generation products--we have gone from having very few products in the
medical countermeasure pipeline over the last decade to funding over 80
candidate products that, if successful, have the potential to
transition to procurement contracts and inclusion in the SNS. These
products include: An entirely new class of antibiotics; anthrax vaccine
and antitoxins; a new smallpox vaccine and antivirals; radiological and
nuclear countermeasures including candidates to treat the various
phases of acute radiation syndrome; pandemic influenza countermeasures;
and chemical antidotes. In many cases, these products represent the
future for enhanced protection of first responders.
Since Project BioShield--the primary tool HHS uses to procure novel
CBRN medical countermeasures for the SNS--was authorized in 2004, HHS
has strengthened internal and external contracting mechanisms, and
research and development pathways, and has incorporated lessons learned
from past challenges. As my colleague at DHS will detail, there is much
discussion about the pre-event vaccination of first responders against
threats such as anthrax. However, the current vaccine regimen is
burdensome as it requires five vaccinations over 18 months and annual
boosters to produce immunity. We all agree that all responders have to
be adequately protected, and if a decision is made to make anthrax
vaccine available to them, it would help to have vaccines that require
fewer immunizations. As part of its efforts to develop vaccines to
protect the entire civilian population, HHS is currently investing in
more than 20 programs for next generation anthrax vaccines, four of
which have transitioned from early to advanced research and
development. The programs have the potential to provide protective
immunity with 3 doses of vaccine or less, are easier to administer, and
have a decreased life-cycle cost due to lack of the cold chain
requirement.
Funding for Project BioShield expires in 2013 and work to
reauthorize the Pandemic and All-Hazards Preparedness Act (PAHPA) is
on-going. The proposed legislation includes the reauthorization of
appropriations for Project BioShield through 2018. Investing in
development of medical countermeasures, novel approaches to response
operations, and our public health infrastructure is critical in
ensuring that adequate medical countermeasures are available for
dispensing as soon as possible following the start of a public health
incident. The reauthorization of PAHPA will support our work and will
ensure we continue to have the tools necessary to respond.
As part of our strategic approach to encouraging innovation in
medical countermeasure development, we are also developing new tools
for all responders and a number of these efforts are already showing
results. HHS is developing a next generation portable ventilator that
will be lighter and less expensive, making it easier and quicker to
administer critical treatments. In 2007, HHS convened a blue ribbon
panel of experts to review the state of ventilators in the market
against the requirements for use in all-hazards preparedness. In
September 2010, an advanced research and development contract was
awarded to Newport Medical in California for design and development of
a next-generation portable ventilator that is at a highly-affordable
price point and that could be used with minimal training on a broad
range of patients from neonates to adults. A prototype was developed by
July 2011 and is currently being evaluated. The initial results are
promising and the program is on schedule to file for market approval in
September 2013.
As we develop medical countermeasures to respond to public health
and medical emergencies we must not ignore the needs of first
responders and their communities after an event. Community-based
responders are the first to arrive on the scene when an incident occurs
and they remain in the community through recovery. A major event such
as an aerosolized anthrax attack will require response and recovery
activities long after the initial threat has passed. First responders
will play a key role in these locally-led recovery efforts toward the
restoration of public health and medical services. First responders are
the backbone of our public health and safety infrastructure; by
supporting them, we ensure that the human infrastructure remains intact
throughout the response and recovery phases, and ready for the next
emergency. Recovery is a part of preparedness, and the National
Disaster Recovery Framework, released in September 2011, provides
guidance to all levels of government, the private and nonprofit
sectors, and individuals and families on activities they can undertake
both pre- and post-disaster to plan for a successful recovery. HHS
leads the Health and Social Services Recovery Support Function under
that framework, and ASPR has established a Recovery Coordination Office
to carry out those responsibilities and also leverage opportunities to
incorporate recovery into on-going preparedness efforts. We have also
supported innovation and continuous improvement in our efforts to
support first responders and others during the recovery phase. Based on
lessons learned in Hurricanes Katrina and Rita, HHS recognized the need
for enhanced coordination of disaster-related health care, mental
health and human services needs at all phases of response. Today HHS'
Administration for Children and Families, in partnership with FEMA,
administers the Federal Disaster Case Management Program, which
provides disaster survivors with a single point of contact for
accessing resources and services to address disaster-caused needs, and
for developing and completing a personalized Disaster Recovery Plan.
While they are not first responders in the traditional sense, our
disaster case managers are on the ground in the aftermath of a disaster
providing support to their fellow responders and impacted individuals.
In addition to supporting officially designated and trained first
responders, we are also leveraging the internet to supplement the first
response. In particular, under the America Competes Act, we are issuing
a ``challenge'' for development of a web-based application able to
automatically deliver a list of the top-five trending illnesses from a
specified geographic region in a 24-hour period. Under the envisioned
program, data would then be sent directly to State and local health
practitioners to use in a variety of ways, including building a
baseline of trend data, engaging the public on trending health topics,
serving as an indicator of potential health issues emerging in the
population, and cross-referencing other data sources. The more we know
and the earlier we understand emerging health trends, the better
prepared we all are--including first responders--in providing treatment
to affected individuals and limiting the impact of the event.
In conclusion, all of our investments and efforts come down to the
same goals--building a resilient Nation and saving lives when
emergencies occur. This is true for all of us, whether in the Federal,
State, local, Tribal, territorial, or private sector. Before coming to
ASPR, I was the director of global crisis management and business
continuity for the Walt Disney Company. In this position I was
responsible for the development and implementation of global policy,
planning, and training to manage crises for The Walt Disney Company. I
was also responsible for East and West Coast Medical and Emergency
Medical Operations as well as the Walt Disney Studio's Fire Department.
My work with Disney required development of strong and productive
relationships with law enforcement, emergency management and
intelligence services counterparts, as well as private sector
counterparts world-wide. Based on my experiences, meeting the needs of
our first responders before, during, and after an event is critical. We
have made great strides toward building a robust enterprise to develop
medical countermeasures and to quickly get them to people who need
them. We are incorporating the clinical community into National
preparedness systems and are preparing clinicians to treat patients
affected by emergencies. We are collaborating with State and local
partners to develop, exercise, and improve their response capabilities.
All of our efforts will ensure the next public health or medical
emergency is responded to in the best, most effective way possible. I
look forward to working with you to ensure that this progress and our
strategies for the future continue to prepare the Nation and save
lives.
Thank you for the opportunity to testify before you today. I am
happy to answer any questions you may have at this time.
Mr. Bilirakis. Thank you for your testimony. I appreciate
it very much.
I will recognize myself for 5 minutes for questions.
This question is for Dr. Polk and Mr. Gabriel. On October
2009, DHS published draft guidance for protecting the health of
first responders immediately following a wide-area anthrax
attack. We know that the first responder community is waiting
for this guidance, and of course, our Ranking Member brought
this up in her opening statement. Of course, the guidance has
since become a joint effort between DHS and HHS. So my
question, of course, is for both of you. Please tell me where
this guidance is and why is it now more than 30 months since a
draft was received and we still don't have the final guidance
published that our first responders can use to prepare for any
type of an event? If you can both address that, I would
appreciate it. Thank you.
Dr. Polk. Sure. Thank you, Mr. Chairman.
First off, I am happy to report both Ed and I have worked
diligently with our counterparts in DHS and HHS on this
guidance to get it moving forward, and it was approved by the
DRG earlier this month. My last understanding is that it is
going through the signature cycle, getting all of the
interagency logos applied to it, and then it will very soon--
within the coming weeks--go through the final interagency
vetting process and then be released.
So I think it was Dr. Garza in his testimony that said we
were rounding third and heading for home, and I think we are
almost home.
Mr. Bilirakis. Okay. So give me a better estimate. Be more
precise as to when you think our first responders will get the
guidance.
Dr. Polk. I think that will depend on if we get any
comments back from the interagency vetting process. If we have
any other comments back from any of the interagency's partners,
it may take a little bit longer to vet those. But I would
imagine we would have that, quite frankly, by mid-May.
Mr. Bilirakis. Why has it taken so long?
Dr. Polk. I think initially, you know--and to be as precise
as I can, a lot of it is to make sure that we had the absolute
best level of evidence to go into the document. Because there
were changes in evolution over the last several years as to
what is the best PPE equipment to use, what is the best
treatment for anthrax, and also, as we had all of these other
different programs come on-line, whether it was vaccination,
whether it was pre-event vaccination or post-event vaccination,
we wanted to make sure that this document was contiguous with
other programs that were coming out, that we did not cause
confusion or actually add to a problem with our first
responders by having one document that said one thing and a
second document that said another that was a follow-on document
for public health. So we wanted to make sure that we vested a
lot of time to get this right the first time.
It is still going to be released as a draft so we can get
public comment when the folks see it because we are under no
guise that we have anticipated all the issues that may confront
the first responders. But we wanted to make sure that we had it
right because these folks, quite frankly, are going to be
rushing into an anthrax event in a hot zone, and this is not
something where we wanted to leave a lot of guesswork.
Mr. Bilirakis. Okay. Thank you.
Mr. Gabriel.
Mr. Gabriel. Well, I have seen the overall document since
getting to ASPR back in November and September, and I have
taken a look at it. I know our offices have been working
closely within our partners at the HHS side, the Centers for
Disease Control, as well as all of our other partners to make
sure that the guidance was clear enough to meet the needs of
somebody who is on the ground.
The issue with anything like this is it can't be perfect.
When you try to look at guidance like this, you want to keep it
as general for the people that are really in the field to
understand and use appropriately. Sometimes when you look at
document development like this, you get a lot of technical sort
of concepts put into something that needs to be operationalized
at the field level. I have seen that from my experiences over
the last.
So we took a good hard shot over the last few months fixing
those gaps and making sure that it meets the needs of
responders more clearly so that when they look at and give us
their input again on this, they are able to say, hey, this will
work in the field. I think that is important. So I think that
we are just a handful of days away from getting this out.
Again, I can't speak for the process above me. But I think the
first responder community will be generally happy with it, when
it gets their visibility on it.
Mr. Bilirakis. Thank you.
Dr. Polk, you discussed in your testimony that your office
is working on guidelines for the use of expiring doses of
anthrax vaccine in the National Stockpile for provisions on a
voluntary basis. You mentioned, of course, to first responders.
We know that such a program is of course a priority. It also
sounds like good Government. We are going to save money. It is
a better alternative to throwing away millions of perfectly
good vaccines. I am sure you will agree. In fact, legislation
under consideration by this committee has asked for that very
thing.
I would like to hear more about the pilot and to understand
your principles for implementation, even though the program
guidance is not yet ready. I would also like to hear how this
program will differ from the unsuccessful smallpox vaccination
effort for health care workers undertaken by the Federal
Government a few years before. So if you could respond, I would
appreciate it.
Dr. Polk. Yeah. Thank you, Mr. Chairman and thanks for the
opportunity to talk about this novel program.
Obviously, DHS has worked hand-in-glove with our HHS CDC
partners on this. As you mentioned, the Strategic National
Stockpile has vaccine that expires every year, sometimes to the
tune of about 2 million doses, $48 million per year, that we
have to recycle, throw out when it expires and recycle. The
goal of this pilot program is to take this vaccine
approximately 6 months before it expires and make it available
to the State and local governments as a prevaccination or pre-
event vaccination program for their folks. Again, I have to
stress it is a pilot, meaning that the goals of a pilot are to
discover where are the gaps, where are the lessons learned
before we distribute this more widely or make this a more wide
program. I believe we have worked diligently with CDC on the
nuances of how to get the logistics of the vaccine from the
stockpile to the State and locals. I believe what they are
looking at right now is the legal departments from each are
looking at, where do we have the authorization to spend
appropriated funds, under what section, whether it is through
FEMA or whether it is through CDC, et cetera, to get the
vaccine there, essentially pay for postage, to make sure that
we can get the vaccine there to the State and locals?
Mr. Bilirakis. Which States are you proposing to
participate in the pilot project?
Dr. Polk. Well, I believe the States are going to, you
know, have an application process to apply and to essentially
allow the States to volunteer. The criteria are going to be
fairly short and succinct. They need to have an occupational
surveillance program so that they can monitor any vaccine
reactions, et cetera. They need to have a good distribution
program. They need to make this voluntary. Those are the basic
guidelines that the States are going to have to use. But we
obviously want to make sure that if they are going to give this
vaccine that they have good follow-up for anyone who has a
vaccine reaction, that they can answer questions, that they can
educate the folks who are going to get the vaccine properly. So
those are the criteria that the States would use initially. So
they are not going to be very rigid. So hopefully we will get a
fair amount of folks that are willing to engage in the program.
Mr. Bilirakis. Thank you.
I recognize you for 5 minutes, Ranking Member Richardson.
Ms. Richardson. You mean 8 minutes and 18 seconds.
Dr. Polk, can you tell me how much has been spent on the
anthrax vaccine and what is the expected shelf life?
Dr. Polk. Well, I can't tell you offhand. The Strategic
National Stockpile is owned by CDC. So I would have to defer to
my colleagues in HHS exactly as to what the cost is that they
spend on that vaccine or what the expected shelf life is. But
typically, FDA has medications for a 1-year shelf life for the
most part. Although certain medications can be extended based
on the type of medication or what buffer are in those
medications to extend their shelf life. But I would have to
defer to my colleagues.
Ms. Richardson. Mr. Gabriel, do you know the answer to
that?
Mr. Gabriel. Well, if the answer is on this card, I do. I
have just been told that we spent $2 billion. It has got a 4-
year shelf life.
Ms. Richardson. Mr. Polk, did I understand you correctly
that hopefully the guidance would be out by mid-May in draft
form?
Dr. Polk. I would hope so. That is assuming that with all
of the vetting that we have done on this document, which we
have done a great deal, that I imagine that we have resolved a
lot of the interagency questions that have come about before.
So, hopefully, it will slide fairly quickly through that
vetting process.
Ms. Richardson. In the second panel, we are going to be
able to ask the question of the letter carriers, what they feel
the impact might be if, in fact, they are experiencing cutbacks
as has been proposed, which I certainly do not support. But
have you had an opportunity to think about--either of you
gentlemen--if the Postal Service is not able to serve in
support of this program, what your other options would be?
Mr. Gabriel. Well, I will start first, and then J.D. will
take it from there.
From a postal model perspective, I was actually out in
Louisville talking to the postal workers directly on this. They
want to volunteer and participate. But they are a piece of an
overall process that involves management, that has come out of
our all-hazards preparedness programs and our BioShield
programs, including points of dispensing, both closed and open
points of dispensing models. The postal model itself, we are
looking at med kits.
So if you look at an overall approach, if the postal model
system begins to show and continues to show that it is
effective, clearly, as we move forward, that has to be in our
arsenal for protecting first responders and civilians.
Ms. Richardson. No, my question was if it is not available
to you.
Mr. Gabriel. We will have to use different models as we
already are.
Ms. Richardson. Is there anything else sufficient to the
level----
Mr. Gabriel. Yeah. I think our points of dispensing models
are good. I think the CDC, working with our DHS partners, have
tested those models across large municipalities where real good
work has been done for a number of years.
Ms. Richardson. Is there any--and I apologize for cutting
you off. But we were called for votes here. I was teasing the
Chairman about extending my time.
Mr. Bilirakis. We are going to try to go another round,
too, if we possibly can.
Ms. Richardson. My question is: Is there any other means--I
realize the CDC has its process. But I don't know of any other
means that could do the actual residence-to-residence
distribution and have that kind of process in place. Is there
anything else that compares to that?
Mr. Gabriel. Resident-to-resident model, hand-delivered,
no, it doesn't exist now. However, the med kit, home med kit
process certainly has some implications relative to that. But
we are not there yet.
J.D., want to answer?
Dr. Polk. Yes. At least from a DHS perspective, I don't
think there is a one-size-fits-all that is going to work in any
particular community. I think whether it is pods, home med
kits, postal model, what may work in a rural area may not work
in an inner city. I think as many models that we can use to
help augment or distribute, to shorten the time for medication
to exposure certainly is going to be supported by DHS.
Ms. Richardson. Okay. Do either of you have any idea of
when the public health emergency medical countermeasures
enterprise plan will be released? That is in reference to
October of last year. GAO reported that between 2007 and 2010,
HHS invested $4.3 billion into countermeasures development,
both the acquisition and research and development. HHS and DHS
updated risk assessments and inventoried the Strategic National
Stockpile that HHS has not updated the countermeasure
investment priorities set forth in the Public Health Emergency
Medical Countermeasures Enterprise Plan of 2007. HHS has
confirmed to GAO that it would release an updated priorities
plan in the spring of this year.
Mr. Gabriel. Let me take that one, councilman--excuse me--
Congresswoman. It is that New Yorker in me testifying in front
of the New York City Council versus the Congress.
So two things about that. Just a little bit about the
overall approach we are doing with this, and then I will give
you a specific answer. We have tried to build this plan by
making sure that whatever we put in this overall program has an
end-to-end approach, so that it is useful on the side for
responders and it has the scientific input. To give you the
quick answer to that, we are expecting release of that by this
summer.
Ms. Richardson. Thank you.
I yield back.
Mr. Bilirakis. Thank you. We are going to try to go another
round. I am going to go ahead and ask one more question, and I
am going to give the Ranking Member an opportunity as well.
Then we are going to have to break for votes. We have three
votes pending, and then we will come right back. We will
dismiss the first panel now, after we finish our questions, and
then we will start with the second panel as soon as we finish
for votes. Okay.
Mr. Gabriel, your agency met with FDA just a couple of
weeks ago to get the FDA's initial thoughts on an approval
process for a first responder antibiotic med kit. There appears
to still be some concerns in the public health and regulatory
community over misuse of antibiotics. In your opinion, do you
think the first responders, as well-educated members of the
medical and law enforcement communities would be likely to
handle the medication appropriately? Can you site any
scientific studies that demonstrate that this might not be the
case? What does your data from the current postal plan suggest?
Mr. Gabriel. Well, thank you for that question. There was a
meeting at the FDA, and there was a discussion about this. I
think both the first responder community as well as the
scientific and medical community talked to this advisory panel
to the FDA. There are two sides to this particular discussion.
But from a perspective--we are excited on our side and are
looking at the med kits as a potential option here from the HHS
ASPR side. The FDA has looked at it and will come to us, get
back to us with more formal regulations or recommendations from
them directly. So to answer on what the outcome is going to be,
I don't know.
However, as a first responder, we are dedicated people. We
are trusted to do a lot of different things in a lot of
different environments. Most of the studies and materials I
have seen on this show that in the past studies that we have
run these kinds of things, the people are dependable to handle
these things appropriately.
However, in the end, the overall recommendation comes
through the FDA, and that is what we are going to wait for. But
first responders every day are going into your houses, taking
care of people with heart conditions, cutting you out of
buildings and doing the things that they put their lives on the
line to do every day. They are dependable people.
Mr. Bilirakis. I definitely agree with you.
Okay, I will recognize the Ranking Member for at least one
question.
Ms. Richardson. You mentioned--well, we talked a little bit
about well it has taken almost 3 years now to get the guidance.
So as we get ready to look at appropriations, you may want to
advise the folks that you work with that it really puts this
project in great vulnerability if we haven't received the
guidance if we want further funding. Since it is coming up to
expire for 2013, what would be the case that either of you
would make of why we absolutely need to continue the program? I
am referring to the BioShield.
Mr. Gabriel. BioShield funds a number of different programs
that we really do need the money for. The whole point of the
dispensing process came through that. We use that funding every
single day for a number of different projects in treating and
preparing emergency response people to be ready during
disaster. BioShield is a terrific program. Overall, there will
be gaps in our ability to move forward on product development
that are already in the pipeline if the funding doesn't come
through. I mean, there is a lot more detail there. But the
answer to the question as straightforward as I can, we want to
make sure it is a continuum of the good work that is done so
far on the projects and developments of countermeasures with
over 80 of them in the pipeline.
In addition to that, we also have used it for the
development and acquisition of incentives to industry to make
sure that the industry has a clear path forward and is willing
to commit to us as a Government to continue to work on these
projects.
Ms. Richardson. Okay. If you could supply to the committee,
if the Chairman does not object, the details of why you think
it is so critical to continue and what are the benefits. Then
if you could also clarify how much of the funds are actually
being spent on expiring products, such as anthrax, oxidants,
and a smallpox vaccine.
Mr. Bilirakis. I do not object. So ordered.
Okay. Well, thank you very much. I want to thank you for
your service. Thank you for your testimony today. Without
objection, what we will do is we will dismiss the first panel,
and then we are going to recess, and we will be returning
following votes. Thank you very much for your patience.
[Recess.]
Mr. Bilirakis. Well thank you very much for your patience.
I really appreciate it.
I want to welcome our second panel. Our first witness is
Chief Al Gillespie. Chief Gillespie is the president and
chairman of the board of the International Association of Fire
Chiefs and serves as the fire chief of the City of North Las
Vegas, Nevada. Chief Gillespie holds a bachelors of science in
fire administration and has completed a fellowship at Harvard's
Kennedy School of Government.
Next, we will receive testimony from Mr. Bruce Lockwood.
Mr. Lockwood serves as deputy director of emergency management
for the town of New Hartford, Connecticut. Mr. Lockwood is also
second vice president of the U.S. Council of the International
Association of Emergency Managers and previously served as
president of the IAEM Region 1. Mr. Lockwood served on the
National Commission on Children in Disasters, where he chaired
the Subcommittee on Evacuation, Transportation, and Housing,
and served as a member of the Subcommittee on Pediatric Medical
Care.
Following Mr. Lockwood, we will receive testimony from
Sheriff Chris Nocco. Sheriff Nocco is the sheriff of Pasco
County, Florida, which happens to be in my Congressional
district, a position he has held since May 2011. Prior to his
appointment by Governor Scott, Sheriff Nocco served as a major
and supervisor of the Pasco County Sheriff's Office Joint
Operations Bureau. Sheriff Nocco has also served as a chief of
staff of the Florida highway patrol and as the deputy chief of
staff to the then-speaker of the Florida House and now U.S.
Senator Marco Rubio.
Sheriff Nocco has also served as a member of the
Philadelphia public school police, the Broward County Sheriff's
Office and the Fairfax County, Virginia Police Department.
During his service in Fairfax, Sheriff Nocco responded to the
September 11 attacks and the anthrax attacks.
Sheriff Nocco received his bachelor's degree in criminal
justice and his masters of public administration from the
University of Delaware.
Finally, we will receive testimony from Mr. Manuel Peralta.
Mr. Peralta is the director of safety and health for the
National Association of Letter Carriers, a position to which he
was elected in July 2010. Prior to pursuing this position, Mr.
Peralta held a number of positions within the National
Association of Letter Carriers.
Welcome.
We welcome all of you. We look forward to your testimony.
Your entire written statements will appear in the record. I ask
you to summarize your testimony for 5 minutes, and I will first
recognize Chief Gillespie.
Thank you very much and you are recognized, sir.
STATEMENT OF CHIEF AL H. GILLESPIE, EFO, CFO, MIFIREE, NORTH
LAS VEGAS FIRE DEPARTMENT, AND PRESIDENT AND CHAIRMAN OF THE
BOARD, INTERNATIONAL ASSOCIATION OF FIRE CHIEFS
Chief Gillespie. Good afternoon, Chairman Bilirakis,
Ranking Member Richardson, and Members of the committee. I am
Al Gillespie of the North Las Vegas fire department and
president and chairman of the Board of the International
Association of Fire Chiefs. The IAFC is a member of the
Emergency Services Coalition For Medical Preparedness.
Thank you for the opportunity to represent fire and EMS
responders today.
My testimony is based upon my experiences as fire chief in
several places, including North Las Vegas. As one of our
Nation's most attractive destinations, we are a high target for
a terrorism attack. My department has a Homeland Security and
Special Operations Division. On 9/11 and the days that
followed, first responders served our Nation with little
concern for their personal health. We have learned many lessons
from the terrorist attacks that day and from the anthrax
attacks later that year.
With Congress' leadership, we have raised preparedness and
training in many areas, but there is more work to do. As chief,
I know my personnel will respond. If you ask me if they would
respond to a fire or a medical emergency, a pandemic or a
biological attack, my answer is yes.
However, numerous studies on the abilities and willingness
of emergency services personnel to respond to pandemics have
uncovered some concerns. The Journal of Occupation and
Environmental Medicine published a study where only 49 percent
of the participants answered that they would be both able and
willing to respond to a biological incident. Another study
published by the Disaster Management and Response revealed that
only 38 percent of responders stated they would respond if
their immediate families were not protected. However, 91
percent reported they would stay on duty if their families and
themselves were fully protected and vaccinated.
Mr. Chairman, the fire and emergency services will do all
we can to protect our communities. We need Congress to do all
it can to protect our first responders and address a major gap
in preparedness for a pandemic or biological bioterrorist
attack. We should not wait for an attack to validate the
surveys and provide absolute proof.
Congress should add language during the conference
committee for the Pandemic and All Hazards Preparedness
Reauthorization Act that focuses on protecting first
responders. Otherwise, a major gap in our National preparedness
system will remain. The IAFC believes Congress should authorize
the Department of Homeland Security and the Department of
Health and Human Services to establish and test a voluntary
anthrax immunization program for emergency first providers. In
addition, Congress should direct these Federal departments to
deploy prepositioned antibiotic kits into the homes of
emergency service providers to protect first responders and
their families. Extending these protections to first responders
and their families will improve preparedness and prevent the
responders from infecting their families.
I would like to reiterate that any anthrax immunization
program should be voluntary. The Strategic National Stockpile
prepositioned regionally includes an anthrax vaccine for
deployment after attack. However, if there is an attack,
immediate emergency response will be provided by local
personnel who are not necessarily immunized. The current plan
calls for the delivery of countermeasures to States within 12
hours of an emergency declaration.
The Federal policy should be changed to set up a pilot
program that rotates nonexpired potent and safe vaccines from
the SNS to voluntary emergency responders' immunization
programs. This would improve preparedness and better utilize
Federal resources and tax dollars. Additionally, this effort
could provide real-world practice for distributing
countermeasures after an attack. As DHS and HHS design the
program, they can create record-keeping guidelines that ensure
that first responders who volunteer for the program receive the
proper and full vaccinations. We have learned that DHS and HHS
are developing pilot programs, as you have heard, to make
vaccines in the SNS available as Federal excess property and
are interested in receiving more information about this
program.
In addition, the prepositioned home med-kit program should
be extended to emergency responders for their families. The
brave postal workers who volunteer to distribute the
antibiotics under the National postal model are provided
prepositioned home med kits covering the individuals and their
families. The CDC conducted a pilot study on the household's
ability to maintain the kit. The study found that of 4,000
households, 97 percent returned their med kits intact. I firmly
believe the emergency response community can be trusted to
follow instructions and maintain med kits in their homes.
Prepositioned med kits into the homes of emergency personnel
will address unacceptable response time gaps and family
concerns. DHS and HHS should develop storage and use
instructions for the kits.
In conclusion, the fire and emergency response is primarily
a local responsibility. Our ability to fulfill our mission
requires proper preparation. Congress must address this current
weakness and enhance emergency response providers' willingness
and ability to safely respond and save lives during a
biological emergency. On behalf of America's fire and emergency
service leaders, thank you for holding this hearing and the
opportunity to address the subcommittee. I look forward to
answering your questions.
[The statement of Chief Gillespie follows:]
Prepared Statement of Chief Al H. Gillespie
April 17, 2012
Good afternoon, Chairman Bilirakis, Ranking Member Richardson, and
Members of the committee. I am Chief Al Gillespie, of the North Las
Vegas Fire Department located in North Las Vegas, Nevada and the
president and chairman of the board of the International Association of
Fire Chiefs. The International Association of Fire Chiefs represents
the leadership of over 1.2 million firefighters and emergency
responders. IAFC members are the world's leading experts in
firefighting, emergency medical services, terrorism response, hazardous
materials spills, natural disasters, search and rescue, and public
safety policy. As far back as 1873, the IAFC has provided a forum for
its members to exchange ideas, develop professionally, and uncover the
latest services available to first responders. The IAFC is also a
member of the Emergency Services Coalition for Medical Preparedness. I
thank the committee for your continued interest in our Nation's medical
countermeasures and for the opportunity to represent fire and EMS
responders during today's hearing.
My testimony is based upon my experiences as a fire chief. As one
of our Nation's most attractive tourist destinations, we in the Las
Vegas area are a high target for a potential terrorist attack. In
response, our department has stood up a Homeland Security & Special
Operations Division composed of emergency management, tactical medics,
urban search and rescue (USAR), technical rescue, and haz-mat rescue
teams.
Our entire department is staffed by over 200 uniformed and civilian
employees who provide a great service to our community. Day in and day
out, I count on each one of these proud and well-trained men and women
to fulfill our diverse missions. As their chief, I know that they will
respond rapidly and professionally when called upon for natural and
man-made disasters.
Throughout the fire and emergency services as we remembered the
10th anniversary of 9/11, we marked the sacrifice our men and women
made that day for our Nation. In the days that followed, the first
responders continued to serve our Nation with little concern for their
personal health. We have learned many lessons from the terrorist
attacks that day and from the anthrax attacks later that year. With
Congress' leadership and support, we have raised preparedness and
training in many areas, but there is more work that can be done.
As I've said, as a chief, I know my personnel will respond. If you
asked me if they would respond to a fire, the answer is ``yes.'' If you
asked me if they would respond to a medical emergency, the answer is
``yes.'' If you asked me if they would respond to a pandemic or a bio-
attack, my answer is ``yes.''
However, in recent years, numerous published studies have uncovered
interesting questions and concerns held by responders. For instance,
the Journal of Occupational & Environmental Medicine published a study
by Columbia University examining the factors associated with the
ability and willingness of essential workers to report to duty during a
pandemic. The study surveyed 1,103 workers from six essential
workgroups in Nassau County, New York and found that although a
substantial proportion of participants reported that they would be able
(80%); much less would be willing (65%) to report for duty. In fact,
only 49% of the participants answered that they would be both able and
willing.
Other studies report similar trends. A study published in a 2007
issue of Disaster Management & Response surveyed paramedics to examine
their concerns about responding to a pandemic. In this study, 80% of
respondents reported they would not stay on duty without protective
equipment or proper vaccination. If provided protective equipment, but
not a vaccine, this rate decreased to 61% of respondents reported they
would not stay on duty. This study also revealed that 91% of the
respondents reported they would remain on duty if they were fully
protected. While that response rate is a good sign, it dramatically
falls to a projected response rate of only 38% if the respondent fears
that their immediate family is not protected.
Mr. Chairman, the fire and emergency services will do everything we
can to protect our communities, but we need Congress to do all it can
to protect first responders and address a major gap in preparedness for
a pandemic or a bioterrorist attack in the United States. Currently, we
only have surveys that suggest a lack of response, but we should not
wait for an attack to provide absolute proof. Your committee has a
strong legislative record of addressing gaps in preparedness from
supporting legislation to allocate the D-Block to public safety to
authorizing grants and other programs for local governments to increase
preparedness capabilities. Although the Pandemic and All-Hazards
Preparedness Reauthorization Act has passed both the House and the
Senate, I am concerned that unless Congress adds language during the
conference committee that focuses on protecting first responders, a
major gap will continue to exist.
As such, the IAFC believes Congress should task the Department of
Homeland Security (DHS) and the Department of Health and Human Services
(HHS) to test and create a voluntary anthrax immunization program. In
addition, Congress should request these Federal agencies deploy pre-
positioned antibiotic kits into the homes of emergency services
providers to protect first responders and their families. The DHS and
the HHS should work together to boost the immunization levels of all
emergency services providers on a voluntary basis and protect
responders and their families. Extending these protections to first
responders and their families (those who live in the responder's home)
will improve preparedness and prevent the responder from infecting
their families during times of great National need.
voluntary anthrax immunization program
First, I would like to reiterate that any anthrax immunization
program should be voluntary. We have heard great debate that an anthrax
attack is a low-risk threat, due in part to the existence of a vaccine.
This vaccine is a major tool in the Strategic National Stockpile (SNS),
maintained by the Centers for Disease Control and Prevention (CDC),
U.S. Department of Defense (DoD) and other Federal agencies, including
HHS and DHS. The SNS's cache of antibiotics, chemical antidotes,
antitoxins, life-supporting medications, IV administration, airway
maintenance supplies, and medical or surgical items is pre-positioned
regionally throughout the country and ready to be deployed after an
attack. However, if there is an attack, immediate emergency response
will be expected by the public. Under current models, this response
will be provided by local jurisdictions whose personnel are not
necessarily immunized. This will result in a major lag in response,
putting public safety and public health at great risk. The current plan
calls for vaccines and medicines to be delivered to any State in the
United States within 12 hours of Federal and State/local declarations.
Each State then utilizes their plan to receive and distribute vaccines
and other medicines, which will result in a lengthier time lapse before
local emergency services and first response are deployed.
Over time, drugs and vaccines in the SNS expire. While a Shelf-Life
Extension Program (SLEP) has been developed for select Federal
stockpiles, other vaccines and drugs are appropriately rotated out of
the SNS and destroyed. Changing Federal policy to set up a pilot
program that rotates non-expired, potent, and safe vaccines and drugs
from the SNS to voluntary emergency responder immunization programs
would greatly improve preparedness levels and better utilize Federal
resources and tax dollars. Additionally, such an effort to rotate and
release vaccines to State and local jurisdictions could provide real-
world practice for the Federal plan to rapidly push out the SNS cache
after an attack.
The DHS and the HHS should work together to develop and test a
voluntary anthrax vaccination pilot program, which ultimately could
address a gap in preparedness and improve emergency response time to a
bio-attack. As these departments design the program, they can create
record-keeping guidelines to assist chiefs ensure their personnel who
volunteer for the program receive the proper and full vaccinations. In
addition, utilizing the SNS could lower the costs of standing up such
an operation while increasing preparedness levels around the Nation.
We have learned that DHS and HHS are developing pilot programs to
make vaccines in the SNS available as ``Federal excess property,'' and
are interested in receiving more information about this type of
program.
pre-positioned antibiotic kits in the homes of emergency responders
Not all bioterrorist attacks can be treated with a vaccine, which
the SNS cache and other Federal programs take into account. The
National Postal Model (NPM) utilizes postal workers who volunteer to
dispense antibiotics after a bioterrorist attack to reduce surge at
dispensing points. The brave postal workers who volunteer to serve
their Nation in such a capacity are provided Household Antibiotic Kits
(HAKs) or med kits. These kits are pre-positioned in their homes and
provide coverage for the individual and their family. This type of
program should be extended to pre-position med kits into the homes of
the emergency responders and further mirror the postal model to include
the emergency responder's family.
The United States Postal Service (USPS) along with HHS, local, and
State public health and law enforcement partners tested the operational
capability to distribute medical countermeasures through the National
Postal Model with three Cities Readiness Initiative (CRI) proof-of-
concept drills (in Seattle, Boston, and Philadelphia) and a
comprehensive pilot in Minneapolis/St. Paul. The CDC also conducted a
Home Med-Kit Evaluation Pilot Study in St. Louis to examine the
household's ability to maintain the kit as directed and preserved for
emergency use. This study found that of 4,000 households, including
first responders, corporation employees, and community health clinic
staff, 97% of participants returned their med kit intact at the end of
the study. While this is just one study, I firmly believe that the
emergency services community can be trusted to follow instructions and
maintain med kits in their home. To do so, instructions for the kits
will have to be developed that address best practices for storage, as
we know that the bathroom medicine cabinet is one of the worst places
to store medications due to temperature and humidity issues.
Pre-positioning med kits into the homes of emergency responders
will address a time gap in preparedness. During an attack, if first
responders are waiting for the release of medical countermeasures from
the SNS to the State and then through public health agencies to
responders, they have indicated through multiple studies less
inclination to report for duty. For a response to disasters or attacks,
this lag time may create an unacceptable situation, and pre-positioned
med kits for emergency responders and their families are warranted.
Emergency response is primarily a local responsibility. First
responders throughout our Nation are rightfully assumed to be able and
willing to respond to emergencies including disasters and attacks.
However, we do not send firefighters to a call without the proper
equipment and training. Our ability to fulfill our missions requires
proper preparation. Congress must address the current gaps to enhance
emergency service providers' willingness and ability to safely respond
and save lives during a biological emergency.
On behalf of America's fire and EMS leaders, I would like to thank
you for holding this hearing and the opportunity to address this
subcommittee. I look forward to answering any questions that you may
have.
Mr. Bilirakis. Thank you, chief, for your valuable
testimony.
Now I will recognize Mr. Lockwood for 5 minutes.
You are recognized, sir.
STATEMENT OF BRUCE LOCKWOOD, DEPUTY DIRECTOR, EMERGENCY
MANAGEMENT, NEW HARTFORD, CONNECTICUT, AND SECOND VICE
PRESIDENT, USA COUNCIL, INTERNATIONAL ASSOCIATION OF EMERGENCY
MANAGERS
Mr. Lockwood. Thank you. Chairman Bilirakis, Ranking Member
Richardson, and Members of the subcommittee, thank you for
giving me the opportunity to discuss the issue of protections
afforded by medical countermeasures and their distribution from
the perspective of the emergency services sector. I am Bruce
Lockwood, deputy director of emergency management for the town
of New Hartford, Connecticut, representing the Emergency
Services Coalition on medical preparedness. I am the second
vice president, IAEM USA, International Association of
Emergency Managers, which has more than 5,000 members worldwide
and is a nonprofit educational organization dedicated to
promoting the principles of emergency management and
representing those professionals whose goals are saving lives,
protecting property and the environment during emergencies and
disasters.
On behalf of the coalition, I thank you for the time
devoted to this topic. These are important hearings in
developing and promoting policies that prepare the Nation and
ensure our resilience. As James Glassman recently noted,
bioterrorism remains a current concern and that, compared with
other defense expenditures, this one on a cost-benefits
calculation, looks awfully cheap. Budgets are constrained. But
to cut back on the only truly effective method of fighting
bioterrorism may be worse than foolish; it could be lethal.
Since Lawrence E. Tan, chief of emergency medical services,
New Castle County, Delaware, representing the coalition
provided testimony in front of this subcommittee on May 2011,
there has been insufficient progress at protecting the
protectors at the local level. This lack of progress means
citizens cannot be guaranteed the continuity of provision of
emergency services in all areas of the country during a large-
scale biological event. I believe there are some simple,
immediate, and commercially sound methods to start providing
protections that would substantially increase our resilience. I
urge you to express your support for a voluntary anthrax
immunization program for emergency services and first
responders.
To complement this immunization program, I urge you to
support the immediate development of med kits for all emergency
services personnel and their households. I believe these are
primary, necessary first steps in ensuring the continuity of
emergency services during large-scale anthrax events. These
steps will mitigate the additional demands on emergency
services during the event and ensure responders can stay on the
job without fear their families are unprotected. During
bioterrorism incidents, protective antibiotics should be
available immediately to the household members of the
responders as well as for the responders themselves. The
critical task established by DHS is that communities develop
processes to ensure that first responders, public health
response, critical infrastructure personnel, and their families
receive prophylaxis prior to the opening of a community pod.
The simplest and most effective manner to achieve this
critical task is by combining immunization with prepositioning
med kits in the homes and workplaces of emergency servicers.
The coalition supports the Institute of Medicine's 2011 report
that rejects the idea of distributing antibiotics to the
general community in favor of targeted population-specific
distribution. Emergency services are that specific population
with specific needs and specific circumstances. There is strong
consistent evidence that we cannot assume emergency services
providers are confident in their ability to serve in large-
scale events, notably biological events. In no professional
category can emergency providers be guaranteed to report for
duty; in cases where they might infect their family members,
less than half would report.
I want to draw your attention to an area of acute concern,
the protection of children. From 2008 to 2011, I served on the
Congressionally-chartered National Commission on Children in
Disasters. The commission report states: Congress, HHS, DHS,
and FEMA should ensure availability of and access to pediatric
medical countermeasures at the Federal, State, and local level.
To ensure this happens, stockpiles must specifically be
developed for children. Further, the children emergency
services need specific measures to ensure their safety while
their protectors are deployed in defense of the community. The
DHS Office of Health Affairs has provided the coalition a
background briefing on a pilot anthrax immunization program.
I support the intent of the program, to protect emergency
services personnel. This use of expiring vaccine could have the
material benefit of the preparedness of the Nation. We must
emphasize the protection of the protectors is paramount, not
the expediency of this stockpile management. The vaccine was
acquired many years ago. Lack of policy on its use is
thankfully now being addressed. The Office of Health Affairs in
its budget hearing before this committee on March 27 requested
an expansion of their countermeasures program for all DHS
employees. I believe this program has been formed by careful
analysis that DHS employees are subject to disproportionate
threat and require special protection.
These same employees and their families work alongside and
are dependent upon local emergency services personnel. The same
protection should be afforded to all emergency services
personnel. Having one leg of the three-legged response system
protected is no protection at all. The Federal Government and
others have gathered the evidence to show that the antibiotic
med kits can safely be administered and antibiotic resistance
is not a scientific concern. For more than 4 years, med kits
have been provided on a voluntary basis to the U.S. Post Office
employees and their families. More than 97 percent of these
kits were returned for renewal unopened. Emergency services
personnel routinely handle equipment and materials that are
more lethal and have more profound consequences than the
antibiotics that would be included in these med kits. Some
responders carry guns; other administer medications to
critically ill patients outside of a hospital, and yet others
work with hazardous materials and life-threatening situations.
Entrusted with these powers and responsibilities, there is
no basis for assuming med kits would be widely abused in the
homes of emergency services. The coalition supports the
development and the distribution of FDA-approved antibiotic
countermeasures to protect from anthrax all emergency services
personnel and their families.
Private companies are interested in developing these med
kits, potentially bringing efficiency to the distribution
administration of a program that could cover all Federal
workers.
The prospect of having a protected Federal workforce
operating alongside an unprotected local emergency services
personnel is something we should endeavor to avoid. Perceptions
that there are different classes of responders would undermine
preparedness. The current methods of medical countermeasures
have not proven capable of meeting our National goals,
including the protection of emergency services sector. New
supplementary approaches are required to ensure those on the
front line of the response community and their families are
protected. Pre-event voluntary immunization and the development
with commercial partners of med kits are part of the next
generation stockpile effort. The prospect of critical
infrastructure failure is real and would be compounded by a
lack of National strategy to protect first responders. The
protection of protectors and their families has been overlooked
and must be addressed. I look forward to answering your
questions.
[The statement of Mr. Lockwood follows:]
Prepared Statement of Bruce Lockwood
April 17, 2012
Chairman Bilirakis, Ranking Member Richardson, and Members of the
subcommittee, thank you for giving me this opportunity to discuss the
issue of the protections afforded by medical countermeasures and their
distribution from the perspective of the emergency services sector. I
am Bruce Lockwood, Deputy Director, Emergency Management, Town of New
Hartford, CT, here representing the Emergency Services Coalition on
Medical Preparedness. I am the 2nd Vice President of the U.S. Council
of the International Association of Emergency Managers (IAEM), which
has more than 5,000 members world-wide. It is a non-profit educational
organization dedicated to promoting the ``Principles of Emergency
Management'' and representing those professionals whose goals are
saving lives and protecting property and the environment during
emergencies and disasters.
On behalf of the Coalition I thank you for the time devoted to this
topic because these are important hearings in developing and promoting
policies that prepare the Nation and ensure our resilience. As James
Glassman recently noted, bioterrorism remains a current concern, and
that ``compared with other defense expenditures, this one--on a cost-
benefit calculation--looks awfully cheap . . . budgets are constrained,
but to cut back on the only truly effective method of fighting
bioterror may be worse than foolish. It could be lethal.''
Since last May when Lawrence E. Tan (Chief of Emergency Medical
Services, New Castle County, Delaware) representing the Coalition
provided testimony in front of this subcommittee there has been
insufficient progress in protecting the protectors at the local level.
This lack of progress means citizens cannot be guaranteed continuity of
emergency services in all areas of the country during a large-scale
biological event. I believe there are some simple, immediate, and
commercially-sound methods to start providing protections that would
substantially increase our resilience.
I urge you to express your support for a voluntary anthrax
immunization program for emergency services and first responders. To
complement this immunization program I urge your support of the
immediate development of a med kit for all emergency services personnel
and their households. Public Health research has shown that the
availability of medical countermeasures for responders and their
families may increase their willingness to report for duty. I believe
these are primary, necessary first steps in ensuring the continuity of
emergency services during a large-scale anthrax event.
These steps will mitigate additional demands on emergency services
during an event, and ensure responders can stay on-the-job without fear
their families are unprotected. During bioterrorism incidents,
protective antibiotics should be available immediately for the
household members of responders as well as for responders themselves.
The critical task established by DHS is that communities ``develop
processes to ensure that first responders, public health response,
critical infrastructure personnel, and their families receive
prophylaxis prior to POD opening.'' The simplest and most effective
manner to achieve this critical task is by combining immunization with
pre-positioning med kits in the homes and workplaces of emergency
services.
The Coalition supports the Institute of Medicine 2011 report that
rejects the idea of distributing antibiotics to the general community
in favor of targeted, population-specific distribution. Emergency
services are that specific population, with specific needs and specific
circumstances.
There is strong and consistent evidence that we cannot assume
emergency services providers are confident in their ability to serve in
a number of large-scale events, most notably a biological event. In no
professional category can emergency providers be guaranteed to report
for duty; in cases where they might infect family members less than
half might report.
I want to draw your attention to an area of acute concern: The
protection of children. From 2008 until 2011 I served on the
Congressionally-chartered National Commission on Children and
Disasters. The Commission report states: ``Congress, HHS, and DHS/FEMA
should ensure availability of and access to pediatric medical
countermeasures (MCM) at the Federal, State, and local levels for
chemical, biological, radiological, nuclear, and explosive threats.''
To ensure this happens stockpiles must specifically be developed for
children. Further, the children of emergency services providers need
specific measures to ensure their safety while their protectors are
deployed in defense of the community.
The DHS Office of Health Affairs has provided the Coalition a
background briefing on a pilot anthrax immunization program. I support
the intent of the program to protect emergency services personnel. This
use of expiring vaccine could have the material benefit for the
preparedness of the Nation, but we must emphasize that the protection
of the protectors is paramount, not the expediency of stockpile
management. The vaccine was acquired many years ago; a lack of policy
on its use is thankfully now being addressed.
I hope that the voluntary anthrax immunization program goals and
outcomes will be developed with local emergency services personnel, and
that the true cost of administering the program is part of future
administration budget requests. Additionally, I hope this new policy
direction of support for pre-event vaccination spurs HHS and the
vaccine development community to further research and development
efforts that will produce a simpler ``next generation'' vaccine that
does not require five doses for full protection.
The Office of Health Affairs in its budget hearing before this
committee on March 27 requested an expansion of their countermeasure
program for all DHS employees. I believe this program is informed by
the careful analysis that DHS employees are subject to disproportionate
threats and require special protections. As our Nation's emergency
response system is primarily local, the key component of our system is
left unprotected by a DHS-only focus. The same protections should be
afforded all emergency services personnel, State, local, and Tribal.
Having one leg (the Federal) of the three-legged stool (Federal, State,
and local) response system protected, is no protection at all.
The Federal Government and other private programs have gathered the
evidence to show these antibiotic med kits can be safely administered,
and that antibiotic resistance is not a scientific concern. For more
than 4 years antibiotic med kits have been provided to volunteers in
the U.S. Post Office employees and their families. More than 97% of
these kits were returned for renewal unopened. Emergency services
personnel routinely handle equipment and materials that are more lethal
and have more profound consequences than the antibiotics that would be
included in the med kits. Some responders carry guns; others administer
medications to critically ill patients outside of the hospital, yet
others work with hazardous materials in life-threatening situations on
a daily basis. Entrusted with these powers and responsibilities, there
is no basis for assuming med kits will be widely abused in the homes of
emergency services personnel.
In a country where it is estimated that there are more than 50
million inappropriate antibiotic prescriptions issued for viral
infections the prospect of resistance is a public health concern. Pre-
positioning med kits with first responders is a microscopic component
of overall antibiotic use, representing less than one-hundredth of 1
percent. Trained personnel in command structures with clinical
oversight can be trusted, as has been demonstrated daily as well as in
times of great stress.
The Coalition supports the development and distribution of FDA-
approved antibiotic countermeasures to protect from anthrax to all
emergency services personnel and their families, as a critical
protective measure against anthrax and other agents. Private companies
are interested in developing these med kits; potentially bringing
efficiency to the distribution and administration of a program that
could cover Federal workers (DHS, USPS) and the entire National
emergency services sector. The prospect of having a protected Federal
workforce operating alongside unprotected local emergency services
personnel is something we must avoid, because perceptions that there
are different classes of responder could undermine overall
preparedness.
The current methods of distributing medical countermeasures have
not proven capable of meeting our National goals, including the
protection of the emergency services sector. New supplementary
approaches are required to ensure that those on the front lines of the
response community and their families are protected.
Pre-event voluntary immunization and the development with
commercial developers of a med kit are part of a next generation
protection and National stockpile effort. The specter of critical
infrastructure failure is real, and would be compounded by a lack of a
National strategy to protect first responders. The protection of the
protectors and their families has been overlooked, and must be
addressed.
Mr. Bilirakis. Thank you for your testimony. I appreciate
it.
Now I will recognize Sheriff Nocco for 5 minutes.
STATEMENT OF SHERIFF CHRIS NOCCO, PASCO COUNTY SHERIFF'S OFFICE
Sheriff Nocco. Thank you.
Chairman Bilirakis, Ranking Member Richardson, committee
Members, thank you for your time.
On behalf of the Pasco Sheriff's Office and the citizens of
Pasco, Florida, I would like to thank Chairman Bilirakis for
the invitation to testify today on the needs and
countermeasures for first responders to a CBRNE attack.
Although some may not believe that this is a clear and present
threat to our community, those of us who are on the front lines
of law enforcement truly understand the gravity of the risk.
Pasco County encompasses 745 square miles and has an estimated
population of 480,000. This does not include our seasonal
residents. Pasco is in the heart of the Tampa Bay region in
proximity to the city of Tampa and the coastline along the Gulf
of Mexico. What I am about to describe is not unfamiliar to
many mid- and large-sized agencies but describes the Pasco
Sheriff's offices.
The consequences of a CBRNE emergency will stretch our
response and recovery capabilities. No matter the nature of the
severity of a CBRNE event, it will be the local first
responders who will provide the initial operational response
and oversee crisis management. The Pasco Sheriff's office is
primary provider of law enforcement services to 89 percent of
the county and provides specialized services and mutual aid to
the four incorporated citizens. We are the first responders at
the forefront of this issue. The State of Florida established
regional teams to respond to CBRNE incidents. When these teams
are selected our Sheriff's Office was not designated as part of
a regional team. If a large-scale CBRNE incident was to occur
in Pasco County, we would be forced to rely upon regional State
and Federal specialists for their response components to assist
with disaster management, investigation, and to provide a
sufficient level of emergency response. Special advice and
resources would also be required as part of the recovery
management phase, including the provision of long-term health
monitoring, psychological support, building and environmental
decontamination, re-establishing public confidence, and
supporting a return to normality.
Understanding that your time is limited and with the
opportunity to speak with you today, I would like to take a few
moments to explain the concerns of the Pasco Sheriff's Office.
These recommendations and thoughts are intended to convey the
perspective not only of law enforcement executive but those of
front-line deputies. Caches of prepositioned personnel and
institutional medical countermeasures should be afforded to law
enforcement first responders similar to the process developed
for postal employees. Law enforcement agencies will be in the
forefront of operations in a biological disaster, and it is
critical that our personnel are available and safe to perform
their duties.
When initiating a program to distribute the anthrax vaccine
for first responders in case of a biological attack, please
allow local law enforcement agencies along with other emergency
services a voice in making the decision as to who will be
defined as a first responder. There are many components of our
sheriff's office that will be in need of this vaccine besides
our sworn deputies. This would include our communications
section and medical staff in our jail, just to name a few.
There are other services in our local government that would
fully support our operations. If they do not enter a hot zone
to support us because they are not properly vaccinated, our
capabilities would suffer tremendously. Local law enforcement
agencies deserve a seat at the decision table when defining the
term first responder because we are the immediate boots on the
ground in any situation. As we are discussing countermeasures,
we need to mention CBRNE protective suits. Although every law
enforcement officer should have a protective suit but does not
at this time, we should immediately ensure our special
operation units have them. SWAT and SERT teams across the
country should be the first provided with protective suits and
equipment to respond to a CBRNE attack. We often think a CBRNE
attack will be a large-scale disaster affecting a large
metropolitan area. One of the main goals of a terrorist is to
maximize fear in a society. What greater fear and easier access
can be achieved with minimal resources required than for a
terrorist to attack a school, church, synagogue, or mall with a
CBRNE component in their operation, such as a dirty bomb. In
such an incident, this would probably include an active shooter
and hostage situation. What greater sense of hopelessness could
we have than if our specialty teams respond very quickly as
they usually will, stood on the perimeter and not be able to
advance in a situation because we are not properly prepared to
go into an active situation that requires protective suits.
Although this hearing is focused on countermeasures, I
would be negligent in my duties to you, the deputies I stand
with, and the citizens we serve if I did not raise the issue of
the most critical piece of emergency response that is still
missing today, interoperable communication. The best plans for
the worst disasters are useless if we cannot communicate with
each other. Today, 10 years removed from the events of 9/11, we
are a country that still has not addressed the greatest
failures, and that is the ability for all first responders to
seamlessly communicate with each other on a secure frequency.
In my humble opinion, this should remain our first priority
for funding, for it is the catalyst for success and the
response to any incident. The Tampa Bay region is in need of a
fully interoperable communications system. As Federal dollars
are distributed for homeland security issues, I would encourage
you to make interoperable communication a top priority.
I thank you for your time. I look forward to your
questions, and may God bless all our first responders.
[The statement of Chief Nocco follows:]
Prepared Statement of Chris Nocco
April 16, 2012
Chairman Bilirakis, Representative Richardson, and Members of the
committee: On behalf of the Pasco Sheriff's Office and the citizens of
Pasco County, Florida, I would like to thank Chairman Bilirakis for the
invitation to testify today on the needs and countermeasures for first
responders to a chemical, biological, radiological, nuclear, or
explosive (CBRNE) attack. Although some may not believe that this is a
clear or present threat for our community, those of us who are on the
front lines of law enforcement truly understand the gravity of the
risk.
Pasco County encompasses 745 square miles and has an estimated
population of 480,000; this does not include our seasonal residents.
Pasco is in the heart of the Tampa Bay Region in proximity to the city
of Tampa and a coastline along the Gulf of Mexico. We are a diverse
community whose No. 1 economic engine is agriculture. In the near term,
we anticipate significant growth in areas of finance, education,
technology, and the health care industry.
The consequences of CBRNE emergencies will stretch our response and
recovery capabilities. No matter the nature or severity of a CBRNE
event, it will be the local first responders who will provide the
initial operational response and oversee crisis management. The Pasco
Sheriffs Office is the primary provider of law enforcement services to
89% of the county and provides specialized services and mutual aid to
the four incorporated cities--we are the first responders and at the
forefront of this issue.
The State of Florida established regional teams to respond to CBRNE
incidents. When these teams were selected, our Sheriff's Office was not
designated as part of a regional team. If a large-scale CBRNE incident
was to occur in Pasco County we would be forced to rely upon regional,
State, and Federal specialist response components to assist with
disaster management, investigation, and to provide a sufficient level
of emergency response. Specialist advice and resources would also be
required as part of the recovery management phase, including the
provision of long-term health monitoring, psychological support,
building and environmental decontamination, re-establishing public
confidence and supporting a return to normality.
Understanding that your time is limited and with this opportunity
to speak with you today, I would like to take a few moments to explain
the concerns of the Pasco Sheriffs Office. These recommendations and
thoughts are intended to convey the perspective not only of a law
enforcement executive, but those of a front-line deputy.
Caches of pre-positioned personal and institutional medical
countermeasures should be afforded to law enforcement first
responders similar to the process developed for postal
employees. Law enforcement agencies will be in the forefront of
operations in a biological disaster and it is critical that our
personnel are available and safe to perform their duties.
When initiating a program to distribute the anthrax vaccine
for first responders in case of a biological attack, please
allow local law enforcement agencies, along with other
emergency services, a voice in making the decision as to who
will be defined as a ``first responder''. There are many
components to our Sheriff's Office that will be in need of this
vaccine beyond our sworn deputies. This would include our
communications section and the medical staff in our jail to
name a few. There are other services in our local county
government that would fully support our operations and if they
do not enter a ``hot'' zone to support us because they are not
properly vaccinated, our capabilities would suffer
tremendously. Local law enforcement agencies deserve a seat at
the decision table when defining the term ``first responder''
because we are the immediate boots on the ground in any
situation.
As we are discussing countermeasures, we need to mention
CBRN protective suits. Although every law enforcement officer
should have a protective suit, but does not at this time, we
should immediately ensure that our special operation units have
them. SWAT (Special Weapons and Tactics Team) and SERT (Special
Emergency Response Team) teams across the country should be the
first provided with protective suits and equipment to respond
to a CBRNE attack. We often think a CBRNE attack will be a
large-scale disaster affecting a large metropolitan area. One
of the main goals of a terrorist is to maximize fear in a
society. What greater fear and easier access can be achieved
with minimal resources required than for a terrorist to attack
a school, church, synagogue, or mall with a CBRNE component in
their operation, such as a dirty bomb? In such an incident,
this would probably include an active shooter/hostage
situation. What greater sense of hopelessness could we have
than if our specialty teams, who can arrive on the scene
quickly, stood on the perimeter not able to advance into the
situation because we are not properly prepared to go into an
active situation that requires protective suits?
Although this hearing is focused on countermeasures, I would be
negligent in my duties to you, the deputies I stand with, and the
citizens we serve if I did not raise the issue of the most critical
piece of emergency response that is still missing today: Interoperable
communication. The best plans for the worst disasters are useless if we
cannot communicate with each other. Today, 10 years removed from the
events of 9/11, we, as a country, have not fully addressed one of our
greatest failures and that is the ability of all first responders to
seamlessly communicate with each other on a secure frequency. In my
humble opinion, this should remain our first priority for funding, for
it is the catalyst for success in the response to any incident. The
Tampa Bay Region is in need of a fully interoperable communication
system. As Federal dollars are distributed for homeland security
issues, I would encourage you to make interoperable communication the
top priority.
Thank you for your time and your consideration of these concerns.
May God continue to bless the men and women of the Pasco Sheriffs
Office and all first responders throughout America.
Mr. Bilirakis. Thank you. Thank you very much.
Now I will recognize Mr. Peralta for 5 minutes.
STATEMENT OF MANUEL L. PERALTA JR., DIRECTOR OF SAFETY AND
HEALTH, NATIONAL ASSOCIATION OF LETTER CARRIERS
Mr. Peralta. Good morning, Chairman Bilirakis, Ranking
Member Richardson, and the Members of the subcommittee.
My name is Manuel Peralta, and I am the director of safety
and health at the National Association of Letter Carriers. It
is an honor to provide information about how letter carriers
are bolstering our National security by participating on a
voluntary basis in a program to distribute medicines to
Americans in the event of a biological attack. I will be brief
because you are busy and because we have mail to deliver. Six
days a week, letter carriers deliver mail to more than 150
million homes and businesses throughout this country, and today
is no exception.
In December 2003, just 2 years after the worst terrorist
attack in American history, President George W. Bush asked the
United States Postal Service to consider delivering antibiotics
to residents of large metropolitan areas following the release
of a biological agent. President Bush and his homeland security
advisors knew that no other entity had a network capable of
carrying out such a mission. He knew further that letter
carriers who are regularly named by the American people as the
most trusted Federal employees, who are ideally suited for such
a complex task.
On February 18, 2004, the Secretaries of Health and Human
Services and Homeland Security, along with the Postmasters
General signed a memorandum of agreement to establish policies
and procedures. The result is the City Readiness Initiatives
Postal Plan, a Federal program led by HHS and designed to help
major cities respond to a large-scale public health emergency
and avert mass casualties by dispensing antibiotics to the
population within 48 hours. President Obama confirmed the value
and the bipartisan nature of this postal initiative through his
Executive Order of December 2009. This order enacts
recommendations inspired by the September 11 commission. Both
Presidents responsible for protecting the American people knew
that no one goes to every address in America 6 days a week, and
no one knows the neighborhoods, like letter carriers.
To date, six communities have become involved: Seattle,
Minneapolis, Louisville, Philadelphia, Boston, and San Diego
County with the cities of Vista and San Marcos. Each program
involves intensive planning and the participation of various
Federal agencies. But one constant is the role of letter
carriers. We look upon this not as a chore but as another form
of service. The Nation's letter carriers, who I am privileged
to serve as an elected officer of the NALC take seriously our
role embedded in the Constitution of providing universal mail
service to every corner of this country, binding this vast land
together and unifying individual communities; all this without
a dime of taxpayer money.
We take equal pride in serving our communities in other
ways, whether conducting the Nation's largest single-day food
drive, as we do every May, watching out for the elderly on our
routes, rescuing someone who has fallen or taken ill, locating
a missing child, putting out a fire, or even stopping a crime.
Service and protection come naturally to letter carriers,
one-quarter of whom are military veterans and who are glad to
volunteer for their country once again, and all of whom have an
affinity for the people in the neighborhoods they serve. The
timing of today's hearing is fortuitous because of the exercise
held last Wednesday in Louisville, which involved a
contaminated truck containing a biological agent and the
response of Federal, State, and local officials. Allen Harris,
president of NALC Branch 14 in Louisville, reports with pride
that several officials went out of their way to praise the
dedication and energy with which letter carriers are engaged in
this effort and that 60 percent of the letter carriers in
Louisville volunteered, 323 men and women. Allen, himself an
Air Force veteran, attributes this in part to the large number
of military veterans in his branch. As Brother Harris puts it,
they already know what it is to serve their country. More
broadly, he says, the extraordinary level of participation
reflects the sense of commitment all his letter carriers have
to the neighborhoods they serve.
``It just makes sense; it makes you feel very proud,''
Allen said, ``because you are doing something that is going to
help the community. I have been on my route for 28 years. I
have seen kids born, go to college, come home, and start their
families.''
Under the Louisville plan, letter carriers would deliver
medicines to 750,000 people. Letter carriers would load 670
cases of medication into 2-ton vehicles from a depository to
which the Federal Government would fly the medicines. Every
home would receive two bottles of medication containing 20
pills apiece along with a flyer. I might add, this type of
planning is nothing new to the Postal Service or to letter
carriers. Indeed, it is one of the factors that led a recent
British study to name the Postal Service as the world's most
efficient system. In fact, Cities Readiness Initiative is one
more example of the value of the unique universal network that
it is and must remain the hallmark of the United States Postal
Service.
In closing, let me say that we are fully aware of the
solemn responsibility we bear as the foot soldiers for this
critical homeland security program, whether in Boston,
Philadelphia, Minneapolis, or elsewhere. It is a duty we
readily accept. We appreciate the confidence placed in us by
Presidents and Homeland Security officials from both parties.
We are continually training and preparing to justify that
confidence. Thank you for your attention and thank you for your
service to our country.
[The statement of Mr. Peralta follows:]
Prepared Statement of Manuel L. Peralta, Jr.
April 17, 2012
Good morning, Chairman Bilirakis, Ranking Member Richardson, and
other Members of this very important subcommittee. My name is Manuel L.
Peralta Jr., and I am the director of safety and health at the National
Association of Letter Carriers.
It's an honor to have the opportunity to provide you with some
information about how letter carriers are bolstering our National
security by participating--on a volunteer basis--in a program designed
to provide medicines to Americans in the event of a biological attack.
Our participation in today's hearing is timely, because just last
week we conducted a table-top exercise for the Cities' Readiness
Initiative in Louisville, Kentucky.
I will be as brief as I can, so that panel has the appropriate time
needed to ask questions--and also because there is mail to deliver
today. Six days a week, the letter carriers of the U.S. Postal Service
deliver mail to more than 150 million homes and businesses throughout
this country, providing the world's best and most affordable delivery
service--and today is no exception.
First, let me provide an historical overview of our involvement
with this program. In December 2003, just 2 years after the worst
terrorist attack in American history, President George W. Bush asked
the U.S. Postal Service to consider delivering antibiotics to residents
of large metropolitan areas during catastrophic incidents--specifically
the outdoor release of a biological agent.
President Bush and his homeland security advisers knew that no
entity besides the Postal Service had an existing network in place that
would be capable of carrying out such a mission. He knew further that
letter carriers, who among other things are regularly named by the
American people as the most-trusted Federal employees, were ideally
suited for such a critical and complex task.
On Feb. 18, 2004, the Secretary of Health and Human Services, the
Secretary of Homeland Security and the Postmaster General, signed a
memorandum of agreement to establish policies and procedures for U.S.
Postal Service distribution of oral antibiotics in response to a
biological terrorism incident.
The result is the Cities' Readiness Initiative--a Federal program
led by HHS and designed to help major U.S. cities increase their
capacity to respond to a large-scale public health emergency and avert
mass casualties by dispending oral antibiotics to the population within
48 hours.
President Obama further confirmed the value--and the bipartisan
nature--of this initiative, through his Executive Order of Dec. 30,
2009, which directed the establishment of a Federal capacity through
the U.S. Postal Service for the timely residential delivery of medical
countermeasures following a biological attack. This Executive Order
enacts recommendations made by the Commission on the Prevention of
Weapons of Mass Destruction Proliferation and Terrorism, an outgrowth
of the September 11 Commission.
Both Presidents, responsible for protecting the American people,
knew no other agency is capable of doing this--because no one else goes
to every address in America, 6 days a week. Further, no one knows the
neighborhoods like the letter carriers.
To date, seven cities in six metropolitan areas have become
involved in this effort--Seattle, Minneapolis, Louisville,
Philadelphia, Boston, and San Marcos and Vista both within the county
of San Diego. They are in varying stages of preparation. Each program
involves a great deal of planning and the participation of a variety of
State, local, and Federal agencies--but one constant is the role of the
letter carriers, who are essentially where the rubber hits the road.
We are glad to volunteer for this mission, and to accept the somber
responsibility that comes with it. We look upon this not as a chore,
but as another form of service. The Nation's letter carriers, whom I am
privileged to serve as an elected officer of the National Association
of Letter Carriers, take seriously our role, embedded in the
Constitution, of uniting the country by providing universal mail
service to every corner of this country, binding this vast land
together and unifying individual communities. All this, without using a
dime of taxpayer money.
And though it is not a term and condition of our employment, we
take equal pride in serving our communities in other ways as well,
whether conducting the Nation's largest single-day food drive, watching
out for the elderly on our routes--or occasionally finding ourselves in
the position of rescuing someone who has fallen or taken ill, locating
a missing child, putting out a fire, or even stopping a crime.
In that spirit, we are particularly gratified to be able to serve
our county in the program I am discussing today. It is a plan to which
we are committed and for which we are ready. Why is that? Because
service and protection come naturally to letter carriers, one-quarter
of whom are military veterans and are glad to volunteer for their
county once again--and all of whom have an affinity for the
neighborhoods they serve, their customers, and the families they watch
grow over the years.
I mentioned that the timing of today's hearing is fortuitous,
because of the exercise held just last Wednesday, which made Louisville
the second city, after Minneapolis, to be formally designated as a
pilot city in the Cities' Readiness Initiative. This followed the March
21 signing ceremony at Louisville City Hall with top officials. The
president of NALC Branch 14 in Louisville, Allen Harris, took part in
the 7-hour exercise, which involved a contaminated truck containing a
biological agent. He did so along with Federal, State, and local
officials from the FBI, county sheriff's departments, city and suburban
health departments, postal inspectors, police departments, Health and
Human Services, and other agencies.
Allen reports, with much pride, two things I will share with you.
One is that a number of these officials went out of their way to praise
the dedication and energy with which the letter carriers are engaged in
this effort. The second is that 60 percent of the letter carriers in
the Louisville branch of the National Association of Letter Carriers
signed up--323 men and women out of 573--to undergo the training, and
deliver the medicines if and when needed. That is in part due to the
large number of military veterans in the branch, according to Allen,
himself an Air Force veteran.
As Brother Harris put it, ``They already know what it is to serve
their country.'' More broadly, he says, the extraordinary level of
participation is attributable to the sense of commitment all his letter
carriers have to the neighborhoods they serve.
``It just makes you feel very proud,'' Allen said, ``because you're
doing something that's going to help the community. I've been on my
route 28 years. I've seen kids born, go to college, come back home to
start their families. It's almost like you're a part of their family.''
Already, Branch 14's union hall has been used some 10 times by
Louisville authorities for training and meetings, because it can
accommodate up to 220 people. Under the Louisville plan, letter
carriers would deliver medicines to 750,000 people in 225,000
households in the city and suburbs in the event of a biological
incident. Letter carriers would load 670 cases of medication into each
of their 2-ton vehicles, from a depository to which the Federal
Government would fly the medicines. There are 48 bottles of medicine
per case. Every home will receive two bottles of medication containing
20 pills apiece, along with a flyer. That has two advantages--it makes
distribution simpler and faster, and it also staggers the times
residents would return to get more medicines.
I might add that this type of planning is nothing new to the Postal
Service or to letter carriers--indeed, it is one of the factors that
led a recent British study from Oxford to name the U.S. Postal Service
the most efficient in the world. In fact, the Cities' Readiness
Initiative is one more example of the value of the unique universal
network that is--and must remain--the hallmark of the United States
Postal Service.
In closing, let me say once again that we are fully aware of the
awesome nature of the responsibility we bear as the foot soldiers for
this critical homeland security program, whether in Louisville or
Boston, San Diego or Minneapolis, or elsewhere. It is a responsibility
we readily and fully accept. We appreciate the confidence placed in us
by Presidents and homeland security officials from both parties--and we
are continually training and preparing to justify that confidence.
Thank you for the opportunity to testify today. I would be happy to
answer any questions you may have.
Mr. Bilirakis. Thank you. Thank you for your service to our
country. Also I thank you for your testimony and thanks for
your patience. I will go ahead and get started. I will
recognize myself for 5 minutes for questions.
For all the witnesses, I am interested in your use of rapid
diagnostic capabilities. Good diagnostics, whether through
physical exam or through a piece of technology, are
indispensable to providing appropriate care, in my opinion.
Diagnostic devices are also considered medical countermeasures
by BARDA. How important are rapid point-of-care diagnostics to
the first responder community? Would it be useful if you had
quick, easy-to-use diagnostics or biological or chemical
threats to help inform your response? Whoever would like to go
first.
Chief Gillespie. Mr. Chairman, thank you for the
opportunity to address that question.
I have got to say, it is extremely important for us to use
all the tools that we have available to us to help determine
the safety of our citizens and the safety of our responders. I
can say that what has happened over the last 20 years, last 10
years particularly, from my point of view in the fire services
is we have made huge strides. We have made tremendous leaps in
our ability to recognize a problem and how we deal with that.
Much of that happened post-9/11, and we made a lot of changes
in how we approach a situation. We know that we can't rush into
every particular situation. The sooner we can get in, the
sooner we can get in, the sooner we can deal with the problems.
So, with immediate diagnostic equipment, whether it be skills
or technology, it certainly is important to us. I will give you
a quick example: We responded in the Las Vegas valley to a
ricin incident. Maybe you didn't hear about it. That is because
none of the first responders, none of our public were injured
or killed because of that particular incident. Because our
first responders were able to determine that they had a serious
problem that may be of a chemical-biological type-nature. The
person who was doing that died from their exposure to the
products but none of our responders were because they were able
to diagnose this early on and keep from becoming contaminated
at the scene.
Sheriff Nocco. Thank you, Chairman.
I concur. Any time we can be proactive instead of reactive
is going to make us safer. Going back to anecdotes, our
agricultural unit has detector devices out there in the field,
and we were able to detect--it was actually a dentist office
that had abandoned their location. However, with the X-ray
machine, there was small chemicals or radiological materials
still left behind. The place had been abandoned. Because of the
detection devices, we were able to be proactive out there and
remove it.
So I concur that anytime we can be proactive out there, it
is going to be beneficial for us. Along with what the chief
said, it is the training aspect of it. The more training we can
provide our first responders, the better they are going to be.
We can give them all the equipment they need, but it is the
training that is going to make them safer.
Mr. Bilirakis. Would anyone else like to respond?
Mr. Lockwood. Yes. Just as the technology with your cell
phone, the devices and items that we utilize continually change
and the technology continues to improve. As we continue to
watch grant dollars continue to dwindle, it becomes more and
more difficult to stay current with those technologies because
they are not exactly cheap as they roll out the new technology.
So I think that those diagnostics, whether it be the training
or the new tools that we are provided, we have to be looking
at, are they being considered sustainment costs? Or are they
being considered a new technology that allows us to do a better
job of meeting the needs of our communities?
Mr. Bilirakis. Thank you. All right. We will move on.
This question is for Chief Gillespie. Your testimony cites
some important concerning studies about the availability of the
first responder workforce during a pandemic. One study you
mentioned found that only 49 percent of survey participants
would be both willing and able to respond, and the other found
that 80 percent would not report for duty in the absence of
personal protective equipment or vaccination. We shouldn't have
to ask responders, in my opinion, to make a choice between
doing their job and protecting their own health and that of
their families.
Given that antibiotics and vaccines are plentiful, it
should be a fairly easy to lift to help responders--and I know
you all agree--to achieve the peace of mind they need to help
them do their job. Why has this taken so long? What is your
opinion on this? What do you think the barriers to reaching
this desire in State are, and is it a matter of cost? I think
not. Or is it a matter of culture? I would like to hear from
Chief Gillespie and anyone else wishing to respond.
Chief Gillespie. Mr. Chairman, thank you for the question.
What do I think the cause of this is? From my opinion,
probably over-analyzation.
I have got to say that our people very much understand the
nature of the problems that we have out in the field. If
somebody has the ability to provide us a tool to perform our
jobs, to be able to protect our citizens and protect ourselves
and our families, I just don't understand why there would be
any reason to delay this. I just don't get that at all.
I am from the Las Vegas area. So I am going to use a Las
Vegas analogy here for you. Every day that goes by is going to
have a cost to it. It is like rolling the dice. You roll the
dice in Vegas, and sometimes you win. But sometimes you lose.
Every day that goes by, we are taking that chance that our
first responders won't need those things that are available to
us today. So it is very frustrating when we hear that it is
there. It is available. It just hasn't been delivered to us
yet.
Mr. Bilirakis. Appreciate it. If anyone else wishes to add
something? Okay. Thank you.
I will now recognize our Ranking Member for 5 minutes or
so. We are going to try to do a second round.
Ms. Richardson. Mr. Peralta, it is good to see you again,
sir, as always. Can you describe for us--I thought it was
interesting you didn't mention in your testimony--the potential
impacts that are being imposed on the Postal Service, how you
would view those impacts or changes, how that could impact your
ability to effectively participate in this model?
Mr. Peralta. Example: The elimination of door-to-door
delivery letter carriers would no longer be able to deliver the
product, the medicine, to your home. As there is some
legislation that proposes to have centralized delivery at the
end of the neighborhood. If I am delivering the product to you
at your home, you don't have to leave your home to get that
medication. If I have to put it at the end of the street in a
cluster box--picture yourself in our gray years of life taking
that walk, fearful, wondering what is going on, to get my meds.
Put it at my doorstep. Let us serve America at your porch.
Ms. Richardson. Thank you, sir.
My next question also for you is, the anthrax attacks in
2001 were particularly harmful for many of our postal workers.
I was curious, are there any lessons learned that you have been
able to take that would also apply to this program as well?
Mr. Peralta. In 2001, one of my predecessors, Al Ferranto,
was the director of safety and health. At that time, the Postal
Service very actively got involved in briefing the NALC,
keeping the NALC informed and in the loop as to what was going
on and literally trying to make sure that we are not exposing
ourselves to any type of a hazard, nor the American people to
any type of a hazard.
We needed to make certain that the mail was safe to
deliver. As a result of that, there has been a lot of
technology applied, radiation to protect against the anthrax in
the mail. The lesson learned is, we have to work together, all
of us, to protect America.
Ms. Richardson. Thank you, sir.
My last question here for you: Are there any resources or
additional support that you would feel that the letter carriers
would need to fulfill this assignment?
Mr. Peralta. I think it leaves the question to be answered
by the experts. How more do we protect the first responders?
The speakers at this table, this panel, speak very importantly
of the need to protect those first responders. Whatever is
learned needs to be passed on to all those first responders.
Ms. Richardson. Are you guys at all currently included in
any first responder discussions?
Mr. Peralta. We are involved in our element of the plan. We
are briefed as to where we are going, what new cities we are
rolling it out in. Then the membership is informed that we are
not going to be put at risk as first responders until the
experts detect that it is safe to start the delivery of the
antibiotics to the community.
Ms. Richardson. But I mean, other than this particular
program, have the letter carriers ever been included in first-
responding situations or----
Mr. Peralta. I apologize. I cannot answer that. I don't
have a recollection off the top of my head.
Ms. Richardson. Okay. If you could supply that to the
committee, that might be helpful.
My next question is for Mr. Lockwood. Over the past 2
years, Homeland Security grant programs have been dramatically
reduced. Can you discuss how cuts to the grant funding has
affected the first responders' ability to do training and
acquire necessary equipment? Because that will be something
that we are going to be voting on very shortly.
Mr. Lockwood. Obviously, any time we lose any funding, it
makes an impact. But in the first years of the grants,
obviously, we saw a rollout of a lot of equipment. The issue is
that, as I stated before, we have the issues of maintenance or
replacement of equipment that we have purchased over the course
of time. Then there is the additional training that goes along
with that. Some of the areas that we have provided equipment
and training to are not things that we necessarily do on a
daily basis so that the currency requirements for training is
more because it is not a daily hands-on activity that somebody
may be dealing with. So we are constantly having to try to make
decisions about how to do more with less.
Ms. Richardson. Okay. Thank you for your answer.
My last question would be to the four of you. Is there
anything that you would like--we have the ability after a
hearing to forward additional questions to the panel. Are there
any questions--I always hate when we have two panels because
you don't really get an opportunity to say, wow, you know, they
should have asked this question. Is there any question that you
would like us to ask Panel I that would be helpful on your
behalf?
We can start here with you, Chief Gillespie.
Chief Gillespie. Thank you, Mr. Chairman and Ranking
Member. I would say--not that I have a question for the panel.
We have already stated forth the charges that we need help from
you, as Members of Congress, to provide services to our
citizens.
But I want to say thank you, also. You end up listening to
a lot of folks here many times, I am sure just asking. I want
to say thank you for the opportunity that I have to be here and
be participatory in some of the major things that Members of
Congress have done for the emergency services. I will state
specifically the D band broadband network issue. Thank you so
much for what happened with that. You heard some of our
problems down here down the road on interoperability. That is
just a small tip of the iceberg. Thank goodness we have the
opportunity to deal with it, though. It is going to take a
little time. We have got to plant the trees to make the shade
for later in the future, but at least we are on the right
track. Thank you for that.
Ms. Richardson. Sure, thank you.
Mr. Lockwood. Mine I guess is not so much a question but a
statement. I would like, as we look at this specific topic
going forward with medical countermeasures, to get the message
across that not necessarily does one size fit all and that we
have got to be open to new methodologies and processes that
will allow us to move forward and advance. We find that there
are days where we are so ingrained in the processes that we are
in, that we struggle with trying to find better ways to do
things.
Ms. Richardson. Thank you.
Sir, you are up for your first-year anniversary in the job.
Sheriff Nocco. Yes. It has been a long year. One comment.
Mr. Polk brought up a very good point. He said, a voluntary
program. There is the anthrax vaccine. It is five shots over 18
months. I would encourage that to continue to be voluntary.
There was a study done that--Florida was included in the
study--that 64 percent of law enforcement officers are willing
to take this vaccine. I think as long as it is voluntary--there
is a lot of education done for it--then we will get even more
participation. So I would think that when you mandate things, I
think people get scared and they get reluctant. When it is a
voluntary program, people are more willing, and I think the
educational component is huge for the success.
Ms. Richardson. Thank you.
I yield back.
Mr. Bilirakis. Okay. I will recognize myself for 5 minutes
or so. You are welcome to stay. I think we still have some time
for some more questions.
This one is for the sheriff, your county being right
outside of Tampa. As a major city and one that receives funding
through the Cities Readiness Initiative, Tampa no doubt has
plans that it has exercised to receive National medical
supplies and dispense them to the public. Given your proximity
to Tampa, has the Department of Health and Human Services
engaged you in any of this planning? Do you feel that your role
and the expectations of your personnel are clear when it comes
to distribution and dispensing of medical countermeasures in or
around the Tampa area?
Sheriff Nocco. Thank you for your question, Chairman. To be
blunt about it, our members are not in the circle. I can tell
you, our emergency operation center, which is not under the
Sheriff's Office, may be involved. But directly our Sheriff's
Office has not been at the table. The city of Tampa and the
county of Hillsborough are doing a very good job putting our
efforts together.
As we proceed, the Pasco Sheriff's Office is a willing
participant. The city of Tampa is utilizing our our resources.
We are sending our people down for possible demonstrations. We
are sending them for mass arrests. We are working that in
conjunction. But as to a distribution, if an outbreak was to
occur, no. I can also tell you very bluntly that our deputies
do not have the equipment to respond if such an incident
occurred, God forbid an anthrax or any type of chemical or
biological attack occurred while our deputy is on the front
line, they would not have protection.
Pasco County, as you know, is literally 10 minutes outside
the city of Tampa at points. We have major critical components
that are going to be involved with the RNC that are secondary
locations, and unfortunately, we do not have the equipment nor
have we received any of the funding. We are working with the
city of Tampa. However those types of conversations we have not
been a part of.
Mr. Bilirakis. Well, that is unfortunate. We have to do
something about that.
This next question is for Mr. Lockwood. I am interested in
your perspective on the consolidation of grant programs and the
impact that it has on projects with a medical focus, such as
those previously funded by the MMRS. Then, has your ability to
maintain and sustain the medical preparedness capabilities you
previously attained using grant funds been impacted? What is
the proper balance, in your opinion, between infusions of
Federal versus State or local funding? I know you have a lot of
interest in this.
Mr. Lockwood. Well, MMRS is clearly one of the areas that
supports us specifically in the first responder community with
the--at least in our area, we have some prepositioned
countermeasures that are available to our first responders. The
problem with those, obviously, become--there is a replacement
cost. There is a cycle where those medications will expire, as
with all the other medications.
I think that one of the other issues is that as this
consolidation process takes place, it is more like a block
grant program. While they will say it is more flexible, it is
actually less flexible in the sense of we see a degrading of
some of the programs we have been able to put together. There
will be programs in my anticipation across this country that
have been built and, at the end of this, may no longer be I
believe to sustain their operations based on just the way the
new structuring has taken place related to the consolidation.
I do also want to point out that there is the 16 grants,
but there is also the HHS grants for public health
preparedness, et cetera. One of the problems we have had in
this process is the coordination between the two of those. We
understand that that is being taken care of in this next grant
cycle. We may have one guidance under DHS aside telling us we
need to do something, but then there is conflicting language
related to what is in the CDC public health preparedness or
ASPR grants.
But I do see that going forward, we are going to continue
to meet challenges in our ability to meet not only the first
responders' abilities from a medical countermeasures
standpoint, but I think that we are going to have these same
problems related to community-based programs.
Mr. Bilirakis. Thank you.
Chief, in the absence of a dedicated med kit, one option to
provide pre-event planning for the first responders is to
establish a dedicated local cache or stockpile. Is a cache
approach a decent alternative to med kits? Have you established
such a cache in your city? Anyone else want to respond on this,
your feelings on this? What do you think, is it a good
alternative to a med kit?
Chief Gillespie. Mr. Chairman, first of all, we have not
established one in our area. Second, it is probably better than
what we have, which is not being included in the first tier.
But certainly far down the list of being able to be utilized
and keep our first responders in the job, responding, knowing
their families and themselves are protected immediately. As you
have heard, there is always a delay out there. One of the
things that we have in emergency services is a lack of time.
Time is important to us. That is how we measure our success in
many ways is how quickly we can respond and how effectively we
respond.
Every second that goes by, when we have to go chase down
something or we have to go to a different location, it makes it
more difficult for us to meet those time requirements. So while
it is better than not having something available, it is not an
ideal situation for us.
Mr. Bilirakis. Thank you.
Sheriff.
Well, whoever would like to respond.
Mr. Lockwood. I just wanted to state that we do have some
prepositioned cache in the greater Hartford area. But one of
the things that I have talked about this on more than one
occasion is the three-event theory; that is, there is the
event. Our secondary event is our ability to distribute our
medications under that guidance that we were given to first
responders before opening the public pod. Then there is the
third tertiary event of actually distributing to our general
public.
The problem becomes--is that there is a 12-hour lag time
most likely for those prepositioned medications to get to us,
to get them out. Secondarily, now we have a resource issue of
having to distribute our medications at the time of need to our
first responders, therefore slowing the response to the third
event. If we were able to preposition the medications in these
med kits in personnels' homes, we wouldn't do away with what we
would greatly reduce that secondary event of having to try and
distribute our medications, our countermeasures to our first
responder community, therefore allowing us to get in a more
rapid approach to be able to get to the general community in a
timely manner. So while prepositioning is an option, and it is
definitely better than what the current alternatives may be,
the ability to close our gap to be able to get to the community
as a whole would be best served by having the prepositioned
kits.
Mr. Bilirakis. Sheriff.
Sheriff Nocco. Mr. Chairman, I agree.
There is a term that is used, keeping your head in the
game. There is no doubt first responders are going to go in and
risk their lives. However, there is another side of it. We are
all human, also. We have families; we have children that we
care about. When these situations occur, it is not going to be
an 8-hour shift, then you go home. These are going to be days
and days on end. We may never get back to our houses. So to
ensure that our families are taken care of, that we don't have
to worry about their well-being, it is going to allow first
responders to be better in their duties. It is going to make us
better as an agency in our response to the community. So if we
can have these caches in the houses, I absolutely agree, that
is the best way to do it. If it is going to be prepositioned in
our police stations and our fire departments and fire stations,
that is better than nothing, as the Chief said. However,
keeping them in our houses, being able to explain to our loved
ones how to use them in case we are not home when a disaster
occurs, I can tell you, it will allow first responders to be
better in their duties.
Mr. Bilirakis. Sheriff, a question for you and again,
anyone else who wants to chime in. Security is a concern
throughout the medical countermeasures dispensing process,
whether in traditional pods or by going door-to-door with
letter carriers. What support, financial or otherwise, does
local law enforcement want from the Federal Government in order
that you can provide the needed support to postal, public
health, and other authorities involved with dispensing these
drugs in an emergency? How can we help you? What support do you
need from us?
Sheriff Nocco. God forbid this ever occur, it is not going
to be a situation that would be isolated just to our county. As
I can imagine, something like this would affect a whole region,
possibly a State. Immediately, our resources would be drained.
We would have to call in the National Guard. We would have to
call in other resources to go with the mail carriers as they go
house to house. I mean, I can't tell you how many mail carriers
we have in Pasco County. But with a population of over 500,000
roughly, including our seasonal residents, I can tell you right
now that we wouldn't have enough deputies to walk with them all
because we have other concerns. You are going to have traffic
issues. You are going to have security issues. You may have a
possible crime scene that we are taking care of.
When most of the time people think of a terrorist incident,
it is one location. Now they have two or three locations
possibly where they are going to try to spread us as thin as
possible. The other agencies where we try to ask for mutual
aid, they are going to be stretched just as thin. So I can tell
you most importantly what we would need is more personnel. More
personnel, the better. Then along with personnel, we are going
to need resources. You know we are going to need food and
water. We are going to need to sustain ourselves. So the
initial is personnel, send us bodies. After that it is going to
continue to say, we need more food. We need clothing, we need
things to keep us going for days and weeks.
Mr. Bilirakis. Thank you.
Last question for Mr. Lockwood. If you were to implement a
voluntary anthrax vaccine program in your jurisdiction, this
would require a well-organized approach and good occupational
health infrastructure to achieve, given the current five-dose
regimen over the 18 months. You mentioned that you touched on
this. What options are in place to do this?
Mr. Lockwood. Well, I think that no communities are the
same. So I can tell you that in most of our larger communities,
we have occupational health within our municipalities or our
governments that would most likely be able to--once given the
guidance and the established protocols on how the program would
be implemented, I am sure they would be able to implement it.
But just like with anything else, we have local emergency
management offices. There may be one individual with a
community of 3,000 people, and we have some that have an
emergency management office with 1 million people. I can't
answer the question from across the country as to how they
would all implement it. But I would think that just like you--
here would be my best answer: In those areas where you have
given us the tools and we have been able to be successful with
them, if you are able to give us this tool, I am sure we will
find a way to be successful with it. I don't think that should
be the stumbling block to this. Because I think that no matter
what, we would be able to get those programs in place because
it is really about protecting the people that work for us.
Mr. Bilirakis. Anyone else want to respond to that? First
of all, I want to thank you all for being so blunt and frank
and giving us all this information. This was very, very
informative. But also I wanted to give you an opportunity to
come up with--just like the sheriff talked about, the
interoperability and then we discuss the grant programs.
Anything else that should be on our radar screen? Any
priorities of yours? How can we help you? I wanted to give
everyone an opportunity to respond.
Chief Gillespie. Mr. Chairman, thank you for the
opportunity.
One of the things that you asked here was, how could you
administer a program? I can tell you that the International
Association of Fire Chiefs is a 501(c)(3) organization that has
had the opportunity to work on major programs like this across
the country dealing with our entire country on intra-State
mutual aid systems and developing programs to get them all tied
together. This would be a great opportunity for something like
our international organization to be involved in and help get
this delivered out to the members of our communities, our fire
service communities, around the country and our other
responders.
And I would also like to say that if you are looking for
beta test groups, I can tell you that the Las Vegas valley is
ready to help be beta test group for your anthrax vaccines and
for your med kits. Believe me, we are ready. We believe we are
on the front lines of and in the sights of the terrorists and
anything we can do to protect our people out there, we would
like to do it before it happens. Thank you.
Mr. Lockwood. I guess my only point would be that from an
emergency management standpoint across our Nation, we have
different-sized offices, different-sized organizations. Some of
these grant dollars are the only things keeping the doors open.
I just caution that--trust me, we all know that these are
difficult times and that we are all doing our best to do more
with less. But as we have looked at different programs that
were potentially coming out or cuts to programs, we may find
ourselves in a situation where the very thing we are looking to
rely on won't be there if we continue to cut as deep as we are
cutting.
So I acknowledge the fact that you guys have a great deal
of work to do, but I just caution you that at the end of the
day, the only thing that keeps our lights on in some places are
some of the minimal funds that we actually do see.
Sheriff Nocco. From the Sheriff's Office standpoint where
we are located, I go back to its interoperability; that is our
No. 1 priority. It is almost like going back to the basics.
That is a basic fundamental issue in law enforcement is to be
able communicate because what we are talking about today is a
worst-case scenario. These are things that we don't even want
to have nightmares about, but they could come true. However,
from our standpoint, it is what we deal with every day, the
disasters that are not to this scale. However, communication
needs to be there. That is the fundamental core of what we do.
It is how we operate, and it is how we can be successful. A
perfect scenario is, the other day I was travelling down the
road. I was in my vehicle. There was a Florida highway patrol
trooper next to me, and there was a Tampa police officer in
front of me. I cannot just pick up my radio and talk to them.
If a robbery had happened or something had broken loose right
in front of me, unless they saw it, there is no way we can
immediately communicate. So I think, from our standpoint, it is
going back to the basics, and it is communication.
Mr. Peralta. Mr. Chairman, if possible, whenever you have
that need, include the letter carriers and Postal Service.
Mr. Bilirakis. Okay. Well, thank you very much, again.
Thanks for making the trip and thanks for your patience, again.
I guess it has been a couple of hours. But again, it was well
worth it, as far as I am concerned.
I thank the witnesses for their valuable testimony and the
Members for their questions. The Members of the subcommittee
may have additional questions for you, and we ask that you
respond in writing. The hearing record will be open for 10
days. Again, we are always available for any input, any
suggestions you might have. Without objection, the subcommittee
stands adjourned. Thanks again.
[Whereupon, at 4:20 p.m., the subcommittee was adjourned.]
A P P E N D I X
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Questions Submitted by Chairman Gus M. Bilirakis for James D. Polk
Question 1a. In response to President Obama's Executive Order on
medical countermeasure (MCM) distribution, your office has taken the
lead for the Department of Homeland Security (DHS) on the conops plan
for mission-essential personnel of the Executive Branch. The Office of
Health Affairs (OHA) has also spearheaded an MCM strategy for DHS
employees, and oversees the purchase and storage of MCMs for the DHS
workforce, which includes stockpiles of countermeasures.
What is the current process for prioritizing DHS' MCM procurement
strategy? Is specific threat or risk assessment information utilized in
procurement decisions?
Answer. Response was not received at the time of publication.
Question 1b. Is there a process for OHA to share lessons learned or
best practices from developing DHS' MCM program with other departments
and agencies, or with first responders who may be trying to develop
their own programs?
Answer. Response was not received at the time of publication.
Question 2a. The DHS Medical Countermeasures Program is intended to
contribute to National resilience by ensuring the timely distribution
of essential medical countermeasures to DHS mission-essential personnel
in the event of a biological attack. The fiscal year 2013 budget
requests $1.9 million to fund medications, training, program support,
and planning activities for this program.
What proportion of DHS mission-essential personnel is covered by
currently stockpiled MCMs?
Answer. Response was not received at the time of publication.
Question 2b. What portion of the requested $1.9 million is intended
to replenish expiring lots of existing stocks of MCM, and then to
acquire new countermeasures?
Answer. Response was not received at the time of publication.
Question 2c. What proportion is designated for acquisition of new
classes of MCMs, such as postassium iodide or influenza antivirals?
Answer. Response was not received at the time of publication.
Question 3. What threats should we be thinking of protecting first
responders against, in addition to anthrax?
Answer. Response was not received at the time of publication.
Question 4a. Beyond that which was provided in your testimony, can
you please provide further details about the voluntary anthrax
immunization program that your office is developing? Specifically:
What is the time line for implementation?
Answer. Response was not received at the time of publication.
Question 4b. What are the expected outcomes?
Answer. Response was not received at the time of publication.
Question 4c. What is the financial arrangement with the localities
chosen to participate--that is, what costs will they bear, and what
costs will the Department bear? How much will these costs total?
Answer. Response was not received at the time of publication.
Question 4d. If fully implemented beyond the pilot stage, will
interested participants be able to use Federal grant dollars to
purchase the vaccine and implement the program?
Answer. Response was not received at the time of publication.
Question 5a. A number of first responders expressed concern to the
committee that Federal grant funding does not apply to medical
countermeasure acquisition for local stockpiling purposes.
Can you clarify whether this is actually the case? What exactly
does the grant guidance say with regard to expenditures of grants on
medical countermeasures, and which Department of Homeland Security
grant programs, if any, are applicable for this purpose?
Answer. Response was not received at the time of publication.
Question 5b. Has the Office of Health Affairs worked with the
Federal Emergency Management Agency to provide guidance on the use of
grant funds for medical countermeasures?
Answer. Response was not received at the time of publication.
Questions Submitted by Chairman Gus M. Bilirakis for Edward J. Gabriel
Question 1. For the purposes of the antibiotic med-kit program that
the Office of the Assistant Secretary for Preparedness and Response
(ASPR) is developing, how is the term ``first responder'' defined?
Answer. Response was not received at the time of publication.
Question 2a. A number of first responders expressed concern to the
committee that Federal grant funding does not apply to medical
countermeasure acquisition for local stockpiling purposes.
Can you clarify whether this is actually the case? What exactly
does the grant guidance for relevant Department of Health and Human
Services grant programs say with regard to expenditures of grants on
medical countermeasures?
Answer. Response was not received at the time of publication.
Question 2b. In BARDA's vision, since the antibiotic med kit for
first responders would be a commercial kit paid for by the responders,
and something that States or local jurisdictions would essentially take
ownership of once Federally approved, will the current grant structure
allow for the purchase of such supplies through Federal grant dollars?
Answer. Response was not received at the time of publication.
Question 3. What is the ASPR's approach to working with the FDA and
ensuring that the FDA understands that med kits are a first responder
and an ASPR priority? How will you ensure a successful partnership?
Answer. Response was not received at the time of publication.
Question 4. How do you envision that the pre-attack dispensing of
medical countermeasures to the first responder workforce would be
tracked? What kind of guidance will your office provide to
participating localities with regard to tracking who has received what
medications, incidence of side effects, and related occupational health
matters?
Answer. Response was not received at the time of publication.
Question 5. Beyond antibiotics for anthrax, what do you envision
med kits for first responders could contain? What threats should we be
thinking about for first responder protection in addition to anthrax?
Answer. Response was not received at the time of publication.
Question 6. How important are rapid, point-of-care diagnostics to
the first responder community? Is BARDA investing in these? Please
provide a list of such diagnostics that have been developed and/or
acquired.
Answer. Response was not received at the time of publication.
Question 7. Can you provide a list of countermeasures and vaccines
in development designed specifically to ensure the continuity of first
responders, or that are being developed for the general public but
would have collateral benefit for first responders?
Answer. Response was not received at the time of publication.
Questions Submitted by Ranking Member Laura Richardson for Edward J.
Gabriel
Question 1. What specific plans have been made to protect the
protectors? Can you provide a list of countermeasures and vaccines in
development designed specifically to ensure the continuity of emergency
services?
Answer. Response was not received at the time of publication.
Question 2. When can an FDA-approved med kit be distributed to
emergency services providers?
Answer. Response was not received at the time of publication.
Question 3. Following the request from OHA for resources to protect
the Federal workforce with countermeasures, can HHS specify what
resources have been deployed to protect local and State responders?
What plans are in place for this protection?
Answer. Response was not received at the time of publication.