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Hearing of the Senate Subcommittee on Oversight of Government Management, the Federal Workforce, and the District of Columbia - Infectious Disease

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Location: Washington, DC

Hearing of the Senate Subcommittee on Oversight of Government Management, the Federal Workforce, and the District of Columbia - Forestalling the Coming Pandemic: Infectious Disease Surveillance

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SEN. COBURN: Thank you, Mr. Chairman. I've read the GAO report. How often do you all drill together? In other words, create a scenario that's not true but respond to it in a coordinated fashion? Anybody want to answer that?

(Laughter.)

MR. : I would mention that we are in the process, and tomorrow in fact, I have a meeting with the people who are putting the report together. We'll be working with the same folks who put together for CDC in Atlanta a series of tabletop exercises on avian influenza.

We're going to do it within the next few weeks here in Washington at the Assistant Secretary of State and Assistant Administrator of USAID level. And we're putting the final touches on that to work specifically on the avian influenza. That's the most recent one I know of related to this sort of activity.

SEN. COBURN: And that will include all the rest of the gentlemen at this table?

MR. : Yes. I think it will include the people -- yes, I believe it will.

SEN. COBURN: Okay. But we've not done that yet, right? We've not said here's a scenario, a false scenario, and we've generated some type of practice so that if we see another SARS or we see an H5N1, do we know what we're doing and that it's going to coordinate?

MR. : We actually are modeling this, in part, on what CDC has done several times already related to avian influenza, but we're bringing it to Washington to work on the agencies who are here.

SEN. COBURN: Okay. Do your systems, your IT systems communicate between the different agencies, DHS, CDC, USAID, the Department of Army? Do they -- do you all have effective communication of your data links?

DR. SMITH: Sir, I find that an excellent question, and I really, really do. And I'm going to be the first one up to the plate here to say that looking toward the future, I think that they absolutely must. I find that Health and Human Services and the Centers for Disease Control are taking the lead with the Office of National Coordination and with the National Center for Public Health Informatics in setting a standard for federal health architecture and setting a standard for the National Health Information Exchange.

We at the Department of Homeland Security are involved in those activities in making sure and certain that our IT systems that are involved, particularly with biosurveillance, are compliant and will be able to exchange information.

SEN. COBURN: So in other words, the answer to the question is the biosurveillance data now is not compatible from agency to agency.

DR. SMITH: Sir, I would not say that that's true across the board.

SEN. COBURN: Well, but it's not totally compatible so that the data you have and the analysis you have is available to all the other groups that we're depending on for biosurveillance.

DR. SMITH: I would have to say that across the board that's correct, sir.

SEN. COBURN: DHS is really kind of at the center of this. Do you all have a program that coordinates right now the integration of data? Or is that what you were speaking to? You're developing that and planning on having that, but you don't have a coordinated integrated program right now so that everything could feed to DHS?

DR. SMITH: Sir, that's correct. That's what we're in the process that we're developing now.

MR. : But senator, I should probably mention that the agreement between CDC and HHS and USAID and others has been to facilitate WHO as the center for collecting much of this information. And so there's been a lot of work that's been put in to making sure that systems are in place that we will flow through WHO a lot of this information, so there is an attempt.

SEN. COBURN: Okay. Well, that's great, so we do have one place. Now, the question is, is do you all have access to all the data that flows into WHL?

MR. : As far as I know, the information we share -- the whole point of that is that information is going to be member --

SEN. COBURN: To get a coordinated response.

MR. : Right.

SEN. COBURN: But does every other group on this panel have access to that information that we have then shared in total?

MR. : The International Health Regulations which WHO has been working on, we're trying to get as many involved in it as possible. The whole requirement of that is that people get that information, or countries get that information at WHO. The expectation, the requirement, is that WHO get it back to the rest of the globe in the appropriate way so that the information is useful.

SEN. COBURN: Right.

MR. : Whether all the countries on that list --

SEN. COBURN: Well, I'm not really concerned about the rest of the countries. I'm concerned about what we're doing and what we're collecting and what we're trying to create in terms of surveillance capability outside of this country. Do we have the IT capability to know what that is if we put it in? I know we're building that at DHS, but what we give up and goes to a centralized collection point, does everybody have access to that now?

For example, if your computers can't talk to DHS but you both can talk to WHO, can Dr. Smith get the information that you've computed at WHO and bring it back to DHS?

MR. : I would need to get an authoritative answer on that --

SEN. COBURN: But do you think it is?

MR. : I believe the answer would be yes. I think anything that we could communicate to WHO we would certainly be able to communicate to each other.

SEN. COBURN: The other question -- I actually have this for the chairman also is should we have had WHO representatives here today, especially our contributors to WHO, and could we maybe ask them some questions on the basis of what we're finding here today and get their input? Because that would have been probably helpful to see what their input since they know what that is.

COL. ERICKSON: Senator Coburn.

SEN. COBURN: Yes, sir.

COL. ERICKSON: If I can just weigh in. In terms of more perhaps pedestrian IMIT capabilities, we use computers and e-mail and push data, use VTCs, telephones, et cetera. The DOD has a very close working relationship with CDC to the point where we are sharing reports. We are sharing isolates. We, in fact, use them as sort of our supreme court where we send those isolates for further confirmation and for selection of isolates for, for instance, vaccine development.

Within the WHO, as I had mentioned in my earlier comment, we have a military medical officer who is assigned there full-time who provides that link to much of that information. In addition, we are a member of the Global Outbreak Alert Response Network, the GOARN, which also provides a forum for getting that information out to the different agencies, many of those represented here.

And so there are good systems in place. We can do better, certainly, that you're alluding to.

SEN. COBURN: Well --

COL. ERICKSON: But I wouldn't want to leave with the impression that we're not --

SEN. COBURN: I know you have the capability to communicate. But the problem we have across the government is we have stovepiped IT programs that are -- very much limit the capability of accessing people who need to know and can utilize the information that you know in a way that's easy.

COL. ERICKSON: Sure.

SEN. COBURN: And that's one of the goals. We spend $65 billion a year in this country on new IT programs, of which $20 billion gets wasted every year. And so this is an important area. If we're going to allow you to be more efficient and functioning better, what we have to do is make sure that everybody's goal is to eventually get to where we can talk to one another through our computers, analyzing data, that we don't have to buy new programs so that one computer can talk to another computer. That was the purpose for the question.

The GAO identified several weaknesses within DHS. One was that there hadn't been consistent leadership at DHS for this program, and that's probably a legitimate criticism, and that's no reflection on you whatsoever. Does DHS have a plan with metrics and milestones for addressing the weaknesses that GAO identified in their report?

MR. GOOTNICK: Yes sir, we do.

SEN. COBURN: And is that plan available to this committee?

MR. GOOTNICK: Certainly, it will be.

SEN. COBURN: Okay. Well, I would very much appreciate a copy of that. I just have one other comment, Mr. Chairman, and then I have to go to the floor to offer some of my dreaded earmark amendments so that we can get money to run the government instead of run the politicians.

I think back to the SARS outbreak. We didn't get a handle, a good handle on that until we stopped commerce. Under the threat of the stop of commerce did we get compliance. And our goal has to be to where we don't have to go to that level, and I know that's what the goal, in terms of trying to build surveillance teams and everything else.

Would any of you care to comment on how we could have done that better and not wasted the time to where we finally had WHO have to issue a travel ban to get compliance out of a foreign country who at first was denying that there was an epidemic. In other words, what it did is that more people died because of the denial that there was a problem.

And I guess my root question is what can we do? As Americans, we can't impinge on the sovereignty of other countries, but can we work better and can we bring to bear forces sooner so that we get the proper reaction? And I'm talking all types of leverage, suspension of aid and all these other things, to get people, when they have the resources and know how to do it, to actually report it? Any comments on that? Yes sir, Dr. Arthur.

DR. ARTHUR: That's exactly the attempt of the International Health Regulations, which came into force for the U.S. in July of this year. There had been a 10-year process to revise those regulations and move away from a list of three diseases to a concept of identifying a particular health threat, so that it would account for new entities such as SARS or the next unknown disease --

SEN. COBURN: Right.

DR. ARTHUR: -- that may occur.

SEN. COBURN: And in your position at CDC, do you feel pretty comfortable that we're not going to see -- because of the new regulations, we're going to see much greater cooperation and much greater coordination because of those?

DR. ARTHUR: I think the international political pressure will, yes, increase dramatically since under the new International Health Regulations, WHO could have gone to China in December when I was in Geneva and first knew about these reports several months before it became publicly known. This was in 2002 -- go to China under the new International Health Regulations and say, "Look, another member state has reported that they see this event. You are required, under the International Health Regulations, to respond in 24 hours and provide that information.

If China then does not do so, then WHO would use other political pressures, other countries and so forth, which now have signed, all 193 countries and WHO have agreed to accept the International Health Regulations. Then, we'd be in a position to leverage tremendous international pressure on China to do the right thing. China would be -- as a signatory to the IHR, they would be required to respond to that.

SEN. COBURN: And so what are the actual teeth of that response? If they fail to respond, what are the teeth? They've signed an agreement. They're not compliant with the agreement. What are the teeth?

MR.: The IHR unfortunately does not have any punitive or penalty assigned to it. So WHO is not --

SEN. COBURN: So therefore, it's going to require courage on the part of the people leading WHO to do a travel ban early, to threaten those things.

MR.: Right, but the information also will be disseminated internationally to all the other countries saying that we have this situation in China. We've asked for information. We don't know what's going on. The WHO director general -- (inaudible) -- determines the event to be a public health emergency of international concern has already pre-rostered a committee that would advise her on the recommended measures that she needs to take place. And it could include travel bans. It could include travel restrictions, whatever. But this would be the international community we'd be dealing with -- (inaudible).

SEN. COBURN: But you would agree. The thing that got action was the travel ban on that. When that was issued, they started cooperating. Is that correct? I mean, full-fledged cooperation -- when there was a travel ban issued by the WHO, what happened? All of a sudden we had admission there was a problem and help, right?

MR.: Yeah, they were very closely timed with each other, yes.

SEN. COBURN: Yes, alright. Thank you, Mr. Chairman, and thanks for holding this hearing.

SEN. AKAKA: Senator Coburn, just to answer your question about WHO, it's not that we haven't thought of them, but we received a message that for whatever reason they would not testify before Congress. So --

SEN. COBURN: Actually, I was wanting our members that come from our country -- to WHO to testify, not WHO. In other words, our delegates, because they represent us there, and I'm certain that we can ask them questions I would hope. You know, it's not surprising that a lot of international agencies are not very transparent and responsive to some of the demands of Congress, even though we contribute to about 25 percent of all their funding. Thank you.

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