Witnesses said more investigation is needed before the recent discovery of anthrax in Florida can be linked conclusively to a deliberate act, but Sen. Bill Frist, R-Tenn., told the Senate Subcommittee on Public Health the threat of bioterrorism or chemical terrorism remains very real.
"Rapid advances in agent delivery technology have made the weaponization of germs much easier," Frist said. "With the fall of the Soviet Union, the expertise of thousands of scientists knowledgeable in germ warfare, trained professionally, may be available to the highest bidder."
Sen. Edward Kennedy, D-Mass., the committee chairman, said a bioterrorist attack would first show up in doctors' offices and emergency rooms. "The actions taken (there) in those first few days will do much to determine how severe the consequences of the attack will be," he said.
Witnesses said the current state of affairs in the public health system cannot guarantee the right steps will be taken quickly enough.
Sen. Max Cleland, D-Ga., testified recent simulations by federal agencies reveal a "woefully inadequate" response to possible threats. Even the Atlanta-based Centers for Disease Control and Prevention, while internationally acknowledged to be the leading authority in dealing with health emergencies, suffers from aging, deteriorating facilities and must be upgraded, Cleland said.
Sen. Jon Corzine, D-N.J., testified the nation's response would rely on a "patchwork" system of state and local capabilities.
"Last Friday, I sat with 34 hospital administrators in New Jersey and discussed this issue," Corzine said. "I came away chilled and sobered by the lack of coordinated planning with regard to biological attacks."
The current competitive system for doling out federal grants is one reason for the disparate plans, both senators and witnesses said.
Sen. Evan Bayh, D-Ind., also a witness, suggested giving each state $5 million per year instead, making that money contingent on the states submitting a training plan to the Department of Health and Human Services. Each state also would receive funding to run simulations for reviewing their response capabilities.
Legislation from committee member Sen. John Edwards, D-N.C., and witness Sen. Chuck Hagel, R-Neb., earmarks $1.6 billion for federal, state and local efforts. The bill addresses shortfalls, in areas such as disease surveillance and vaccine stockpiles, pointed out by a recent General Accounting Office study.
More than $500 million in funding would go toward block grants for state and local activities, including $55 million for first responders, $100 million for hospital preparedness, and $50 million for laboratory readiness.
Federal vaccine and antibiotics research and stockpiling programs would receive $571 million, while grants for increased hospital emergency capacity would total $154 million. Agricultural and food safety programs would get $350 million.
Future efforts must focus on improving the communications and availability of local and regional public health organizations, said Dr. Mohammad Akhter, executive director of the American Public Health Association.
Ten percent of the nation's 3,000 local health agencies do not even have e-mail, Akhter testified. Immediate, direct communications between those agencies and emergency medical personnel is essential in defeating an attack, he said.
"Most of them are 9-to-5 operations," Akhter said. "If there is an outbreak on Friday afternoon, there would be nobody there to take care of them ... until Monday. The window of opportunity to deal with infectious agents is 24 to 48 hours. I suggest we look at the regional approach, get these agencies together and have someone available 24 hours a day, seven days a week."
A $1.9 billion funding proposal from the multidiscipline Workgroup on Bioterrorism Preparedness would focus on these issues, said Michael Osterholm, director of the University of Minnesota's Center for Infectious Disease Research and Policy. The group would spend $835 million on state and local preparedness, including preparedness planning -- $35 million -- and information and communication systems -- $200 million. The remaining funds would cover areas such as creating federal expert response teams and international surveillance.
"Preparing for (an attack) will also prepare us for the daily barrage of exotic agents from abroad, antibiotic-resistant microbes and the ever-growing problem with food safety," Osterholm testified. "This represents the very essence of dual purpose resources."
Many comments during the hearing indicated additional research is needed to properly cover the U.S. population. Committee member Sen. Hillary Clinton, D-N.Y., said the needs of children, including proper vaccine dosages and smaller gas masks, must be considered. Akhter said the nation must seriously review the idea of inoculating emergency medical personnel against likely bioterrorist diseases.