CONTENTS Fleming, David, M.D., Deputy Director for Public Health Science, Centers for Disease Control and Prevention, U.S. Department of Health and Human Services; and David Tornberg, M.D., M.P.H., Deputy Assistant Secretary, Health Affairs, U.S. Department of Defense Selecky, Mary C., secretary, Washington State Department of Health, president, the Association of State and Territorial Health Officials; Seth L. Foldy, commissioner, medical director, city of Milwaukee, health commissioner, chair, National Association of County and City Health Officials, Information Technology Committee; Karen Ignagni, president and CEO, American Association of Health Plans; and Julie Bell, Hon. Chris, a Representative in Congress from the State of Texas, 122 Fleming, David, M.D., Deputy Director for Public Health Science, Centers Article from Emerging Infectious Diseases Foldy, Seth L., commissioner, medical director, city of Milwaukee, health commissioner, chair, National Association of County and City Health Officials, Information Technology Committee, prepared statement of Hall, Julie, medical officer, World Health Organization, prepared state- Ignagni, Karen, president and CEO, American Association of Health Selecky, Mary C., secretary, Washington State Department of Health, president, the Association of State and Territorial Health Officials, Tornberg, David, M.D., M.P.H., Deputy Assistant Secretary, Health Af- 25 HOMELAND SECURITY: IMPROVING PUBLIC HEALTH SURVEILLANCE MONDAY, MAY 5, 2003 HOUSE OF REPRESENTATIVES, SUBCOMMITTEE ON NATIONAL SECURITY, EMERGING THREATS AND INTERNATIONAL RELATIONS, COMMITTEE ON GOVERNMENT REFORM, Washington, DC. The subcommittee met, pursuant to notice, at 2:01 p.m., in room 2154, Rayburn House Office Building, Hon. Christopher Shays (chairman of the subcommittee) presiding. Present: Representatives Shays, Murphy, Janklow, and Bell. Staff present: Lawrence Halloran, staff director and counsel; Kristine McElroy, professional staff member; Robert A. Briggs, clerk; David Rapallo, minority counsel; and Jean Gosa, minority assistant clerk. Mr. SHAYS. A quorum being present, the Subcommittee on National Security, Emerging Threats and International Relations hearing entitled, "Homeland Security: Improving Public Health Surveillance," is called to order. As we convene here today, the world is conducting an involuntary, live-fire exercise of public health capacity against bioterrorism. Severe acute respiratory syndrome [SARS], emerged from the microbial hothouse of the Far East through the same vulnerabilities and vectors terrorists would exploit to spread weaponized, genetically altered disease. The global response to SARS underscores the vital significance of sensitive disease surveillance in protecting public health from natural and unnatural outbreaks. It also discloses serious gaps and persistent weaknesses in international and U.S. health monitoring. The lessons of the West Nile virus and mail-borne anthrax have not gone unheeded. Substantial enhancements have been made to the accuracy, speed, and breadth of health surveillance systems at home and abroad. The limited impact of SARS here can be attributed in part to increased preparedness to detect, control, and treat outbreaks of known and unknown diseases. But the public health surveillance system at work today against SARS is still a gaudy patchwork of jurisdictionally narrow, wildly variant, and technologically backward data collection and communications capabilities. Records critical to early identification of anomalous symptom clusters and disease diagnoses are not routinely collected. Formats for recording and reporting the same data differ widely between cities, counties, and States. Many key records are still generated on paper, faxed to State or Federal health au thorities, and entered manually one or more times into potentially incompatible data bases. In a world made smaller by the speed of international travel and the rapid mutation of organisms in our crowded midst, the interval between local outbreak and global epidemic is shrinking. Virulent, drug-resistant organisms easily traverse the geographic and political boundaries that still define and inhibit public health systems. Efforts to build a more modern "system of systems," envision routine collection and rapid dissemination of real-time data from public and private health systems and laboratories. Early warning capabilities would be enhanced through the fusion of innovative syndromic surveillance-automated screening of emergency room traffic, pharmacy sales, news wires, and other public data streams for potentially significant signs of an outbreak. Pieces of this planned health monitoring system can be assembled at different times and places, but no fully national system yet integrates the observations and communications needed to protect public health from rapidly emerging biological hazards. Successfully operating the elaborate, elegantly sensitive surveillance network of the future will require unprecedented levels of human skill, fiscal resources, medical information, and intergovernmental cooperation. At this moment, sophisticated radars scan the skies and the seas to detect the approach of forces hostile to the peace and sovereignty of this Nation. A similarly unified, sensitive system of disease sensors is needed to detect the advance of biological threats to our health and prosperity. Testimony today will describe civilian and military programs under way in the United States and abroad to overcome the natural and man-made barriers to health monitoring. We deeply appreciate the dedication and expertise all our witnesses bring to this important discussion, and we welcome their participation in our oversight. At this time, we will call on Mr. Bell, who is the acting ranking member today. Mr. BELL. Thank you, Mr. Chairman. I would like to thank you and those who are providing testimony before the committee here today. Today's hearing is critically important to this Nation's security and the safety of its health in general. We are all aware of the need to detect the outbreak of disease and respond immediately and effectively. This could be no clearer than in my congressional district, which is home to the world's largest medical center in the world in Houston, TX. Public health surveillance has been described as "the cornerstone of public health decisionmaking and practice." The events of September 11, 2001, and the subsequent anthrax attacks raise the profile of this issue significantly, so much so, President Bush proposed the creation of "a national public health surveillance system to monitor public and private data bases." He argued that the anthrax attacks of October 2001 prove that quick recognition of biological terrorism is crucial to saving lives; and he proclaimed an urgent need to integrate the Federal interagency emergency response But what concerns me most is that there has been no evidence of any attempt to follow through on this proposal. Additionally, the administration's fiscal year 2004 budget slashes funding in core Centers for Disease Control functions. I would hope that our witnesses can clear up the discrepancies between the administration's rhetoric and its proposed funding levels, and I look forward to your testimony. Thank you, Mr. Chairman. Mr. SHAYS. Thank you, Mr. Bell. At this time, the Chair would recognize Mr. Janklow. Mr. JANKLOW. Thank you very much, Mr. Chairman. I am going to be extremely brief. If you go back to the period of time just a couple of short years ago when those anthrax letters were mailed around the country, they had the anthrax outbreak, the situation down in the Carolinas, the reality of the situation is, from and after that point in time, phenomenal things have been accomplished. But as you indicated, Mr. Chairman, in your opening remarks, we still have a patchwork in this country that we have a responsibility to overcome very, very quickly. We have cities that have public health laboratories and counties with public health laboratories. We have prisons with public health laboratories. We have States that have public health laboratories; we have private health laboratories. The Federal Government has Indian health service laboratories, they have public health service laboratories, they have military laboratories. We have a whole host of different laboratories, reporting centers in this country, and still a large amount of it is based upon paperwork. And it is incredibly important, it is really incredibly important that in today's day and age, when it is not that difficult to put together reporting systems based upon electronic meansand not facsimile, but far more modern electronic means that this be done in the most expeditious manner. The Centers for Disease Control frankly have accomplished phenomenal efforts in terms of working with local communities, working with States and communities over the last couple of years. But notwithstanding all the accomplishments that have been made, Mr. Chairman, the fact of the matter is, we are not where we have to be, we are not where we want to be, and we are not where we should be. And so anything that can be done to speed that process up can only be of a beneficial nature to the people of America. Thank you very much, Mr. Chairman, for giving me this opportunity. Mr. SHAYS. I thank the gentleman for this statement. Mr. Murphy. Mr. MURPHY. I will wait and ask questions. Mr. SHAYS. Wonderful to have you all here. You all are such wonderful, active members of this committee. Before recognizing our witnesses, let me just get some housekeeping in place here, and ask unanimous consent that all members of the subcommittee be permitted to place an opening statement in the record, and the record remain open for 3 days for that |