Mr. JANKLOW. OK. Ms. SELECKY. The learning from this is what's essential in that whether Mr. JANKLOW. Will that be shared with people all over the country? Ms. SELECKY. Yes, the results of that will be. Yes. Mr. JANKLOW. OK. Ms. SELECKY. In terms of the communicable disease, for example, that will be used in the Chicago venue and it will be pneumonic plague-it's a matter of what systems are in place, are people reporting electronically now? No, not everywhere; and it will be as important in a rural area as it will be in an urban area. Mr. JANKLOW. Excuse me for a second.. Ma'am, you look shocked. You are sitting there looking at me shocked. Is there a reason? Ms. Ignagni. Ms. IGNAGNI. Well, I didn't mean to interrupt. But you did read me correctly. And it's not shock. It's I think that there is something in addition to the electronic issue. But I would be happy to wait until our colleagues finish answering their question. But you registered my being perplexed as I was thinking about your question. I think there is something that we have been missing all afternoon, frankly. But I don't want to be rude and interrupt your Ms. SELECKY. No. If you've got it, go for it. Ms. IGNAGNI. Well, no. I don't know if I have it. I wouldn't want to be presumptuous. I'm the only one on the panel that isn't a physician. But in my humble opinion, in looking at the reports by the Institutes of Medicine, the General Accounting Office, the World Health Organization reports, where we are going wrong in our country in terms of bioterrorism readiness is that for too long we have thought of the health care system as what happens in the hospital. Now that's a very important part of the health care system, but I can tell you that what we did and we're just beginning our demonstration program. But we did a dry run in Massachusetts, and what we found is that people were reporting symptoms into our system a full 2 weeks before people ended up in the hospital. So, sir, when you asked the question is there something more important than electronic, I was sort of shaking my head and intuitively going through all this information. And I didn't want to sound presumptuous in sharing with the committee the idea that I do think the comments that have been made, particularly by the GAO about their reliance on passive reporting, is something that we really have to get our hands on and we have to figure out how do we go to real-time. It's not just about electronic, though. Mr. JANKLOW. If I could ask that the three of you from American organizations, and just whoever wants to answer first or only-be the only one, what do we need to do to fix this? If your children's lives depend on it, your neighbors' lives depen on it, is this a congressional fix? Is it a Presidential fix? It is a health community fix? I've heard people say that lawyers and judges can't fix what's wrong with the legal system, and that doctors and hospitals can't fix what's wrong with the medical system. It takes outsiders who have a different perspective, who are really not the producers but Let me ask you. What does it take to fix this? Because we are all frustrated. Dr. FOLDY. Well, until the information can flow rapidly, we are missing an essential part of the fix. Ms. Ignagni brings this up. The next point, which is do we really know-there is a lot of science that needs to be done and needs to be done ideally Mr. JANKLOW. You said-I think your quote was, young science easily oversold. Dr. FOLDY. So, for example, she raises one of many very interesting and answerable questions: What part of the health system or other human behavior Mr. JANKLOW. OK. But, sir, how do we get there? Dr. FOLDY [continuing]. Serves as an early detector. Mr. JANKLOW. We are in the third year of the war. How do we get there? How do we wind this up? Dr. FOLDY. I would like to see a lot of the best people in Federal agencies, including the different agencies within the Centers for Disease Control, be given an office and some money and some contact with the best people in informatics, intelligence, Defense Department, even financial systems. I mean, I can draw cash out in Taiwan, but I can't see surveillance figures in my own den. And there is a lot that can be learned quickly if people can be brought together, apply sustained attention to the problem over the next few years, while having-starting to get the electronics information that Mr. JANKLOW. If I could ask you, sir, if you would just submit to the committee a list of who you think ought to be at that table by organization. Dr. FOLDY. My local perspective, and therefore very imperfect perspective. Mr. JANKLOW. Sure. Dr. FOLDY. Yes. Mr. JANKLOW. Ours is perfect, sir. Yours isn't. No, we understand that. In the most base sense, we all understand that. But if you would, because you can tell by our questions, all of us, we don't know what to do, but we don't think what's being done necessarily is working. If someone is going to attack us tomorrow, are we ready? The answer is, no, we are not if they are going to be spread around-if they were to spread this around. We have seen what hoof and mouth disease can do to Europe, to the livestock industry. I can't believe that something wouldn't be akin to human beings if they had the same type of disease for people. I know they do have that one, but I'm not talking about Banks dis ease. Thank you, Mr. Chairman. Mr. SHAYS. I would just point out, though, that's one form of terrorism; and that's not just the attacks on human beings but the attacks on livestock could be devastating. Mr. Bell, you have the floor. Mr. BELL. Thank you very much, Mr. Chairman. and I would ask unanimous consent for her written testimony to be submitted for the record. Mr. SHAYS. Without objection. And she is with Mr. BELL. Trust for America's Health. Mr. SHAYS. Thank you. [The prepared statement of Dr. Hearne follows:] Subcommittee on National Security, Emerging Threats, and International Relations Mr. Chairman and members of the Subcommittee, thank you for the opportunity to submit testimony on the importance of improving public health surveillance as an essential step toward bolstering our homeland security. My name is Dr. Shelley Hearne, and I am the Executive Director of the Trust for America's Health (TFAH) and the Chair of the American Public Health Association (APHA) Executive Board. TFAH, a nonprofit, non-partisan advocacy group, is dedicated to protecting the health and safety of all communities from current and emerging health threats by strengthening the fundamentals of our public health defenses. A strong public health defense begins with disease surveillance, which is why today's hearing is so important. Public health surveillance, also known as health tracking, not only helps us monitor and mitigate potential chemical and bioterrorist attacks, but also is crucial to unlocking the mysteries behind chronic and infectious diseases. Tracking disease is one of the most vital weapons public health officials have in the fight to prevent and control threats to the country's health. Public health surveillance is defined as "the ongoing, systematic collection, analysis and interpretation of health data essential to the planning, implementation, and evaluation of public health practice, closely integrated with the timely dissemination of these data to those who need to know." A comprehensive disease tracking system monitors the occurrence of disease and can inform the rapid identification of outbreaks or "clusters" of cases and analysis of geographic variations and temporal trends. With this information in hand, public health investigators can search for the sources and routes of exposure to determine why the outbreak occurred, how to prevent similar outbreaks in the future, and, if the outbreak is ongoing, how to prevent others from being exposed. Concurrently, action must be taken to control the spread of the disease and minimize further illness and death, even when clear cause and effect have not been fully identified. Thacker, S.B. and Berkelman, R.L. Public Health Surveillance in the United States. Epidemiology The public health community overwhelmingly agrees: health tracking works. Unfortunately, up until now, we have lacked the resources and national resolve to make effective, comprehensive health tracking a reality. The new threats of potential chemical and bioterrorism, combined with emerging health crises like severe acute respiratory syndrome (SARS) and West Nile Virus, mean that health tracking is even more essential. Now is the time for Congress to make it a national priority. Even limited health tracking efforts have already helped us make advances toward improving the health of communities. For example, through health tracking information, we have been able to better understand how West Nile Virus is spread. The good news is that as we are working to prevent these possible and emerging health dangers through public health surveillance, we can put this same tool to work to curb and control existing chronic disease epidemics, from cancer to asthma to diabetes. Seventy percent of Americans will die from a chronic disease. At the same time, according to the Centers for Disease Control and Prevention (CDC), approximately 70 percent of these illnesses are preventable through strong public health measures. As we work to improve public health surveillance efforts, we must also realize that our entire public health system is in urgent need of revitalization and modernization. It is no secret: the current system is painfully under prepared to meet the public health threats that Americans face today. In the past, the U.S. public health system served as the world leader in stamping out diseases like yellow fever, typhoid, influenza, and cholera. Just as the world is looking to our country for leadership in the war against terrorism and the worldwide SARS epidemic, the United States also should be at the forefront of the global war against modern disease. Instead, we find our public health defense system ailing: the 2001 CDC report Public Health Infrastructure stated the current U.S. public health infrastructure "is still structurally weak in nearly every area." The report calls for a system of "public health armaments," including a "skilled professional workforce, robust information and data systems and strong health departments and laboratories." In a separate report, the General Accounting Office (GAO) found that "the 1999 West Nile virus outbreak, which was relatively small, taxed the federal, state and local laboratory resources to the point that officials told us that CDC would not have been able to respond to another outbreak had one occurred at the same time." According to the GAO report, coordination between state, local and federal authorities, communication systems, disease surveillance, staffing and laboratory capacity are areas that require immediate improvement. In order to provide public health surveillance that bolsters homeland security, we must focus on: national authority and commitment to disease tracking standards and reporting systems; rapid communication links with all health agencies, hospitals, first responders and laboratories; modern and compatible equipment; and a trained workforce. Sadly, many of these elements are missing currently. Consider: The lack of national coordination - mandated standards, support and enforcement. CDC does not have a command and control mentality with respect to surveillance. The most recent example is the agency's unwillingness to require that SARS be considered a reportable disease in every state. In fact, most of the nation's disease tracking systems |