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Hearing Of The Senate Homeland Security And Governmental Affairs Committee - Federal Response To H1n1 (Swine Flu) Virus

Statement

By:
Date:
Location: Washington, DC

Chaired By: Senator Joseph I. Lieberman (I-CT)

Witnesses: Janet Napolitano, Secretary Of Homeland Security; Adm. Anne Schuchat, M.D., Interim Deputy Director, Science And Public Health Program, Centers For Disease Control And Prevention

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SEN. LIEBERMAN: (In progress) -- confirmed cases in six states: New York, California, Texas, Kansas, Ohio, Indiana.

Globally, excluding Mexico and the United States, there are 39 confirmed cases in six other countries, including New Zealand, Spain, Great Britain, Germany, Canada and Israel.

On Sunday, our government declared this to be a public-health emergency. A day later, the World Health Organization raised its pandemic alert to phase 4. So this is no media-created or media- exaggerated story, as some have suggested. This is a genuine public- health crisis.

The reassuring news, I believe, is that this is a case in which our government was prepared for the crisis as best one can be prepared for a swine flu outbreak whose course is not clear. And our top government officials responsible for responding have done so, I think, with great strength and effect.

The fact is, as I said, that we don't know the course that this disease will follow. It is possible, as have some -- as some have suggested, that the incidence of swine flu may diminish in the weeks ahead and then return with a vengeance in the flu season later this year.

So the American people are understandably anxious, and want to know what they can do to protect themselves and what their government is doing and will do to protect them from swine flu.

This morning, we have two people with us who are really best prepared and most responsible for answering those questions. Secretary of Homeland Security Janet Napolitano is the person in our government given the authority and responsibility by statute and presidential directives to be the overall emergency manager of the federal government's response to this kind of threat. That reminds us that this newest of federal departments, created in the aftermath of the terrorist attacks of 9/11/01, was, from the start, intended to be at the center of prevention and response not just to terrorist attacks but to natural disasters and to pandemic outbreaks, which, in many ways, mirror the effects of a potential attack by a weapon of mass destruction.

In the current attempt to limit the spread of swine flu, the presence within the Department of Homeland Security of not just the Federal Emergency Management Agency, FEMA, but also of agencies that concern and control immigration and access in and out and across our border, such as ICE -- Immigration and Customs Enforcement -- Customs and Border Patrol (sic) and the TSA, has been very important to consolidate the response, as has been the ongoing relations that the secretary of Homeland Security has with state and local officials.

This -- Admiral Schuchat is here this morning representing the CDC, which works under the Department of Health and Human Services in this case and its new secretary, Kathleen Sebelius. That department, in turn, leads the public-health and medical-response parts of the federal government plan now being coordinated by Secretary Napolitano.

I thank you both, and all who have worked with you in the last several days, for your rapid, strong and reassuring response to this public-health crisis. You've tracked the spread of the disease, identified and addressed new cases in this country, communicated your findings frequently to the American people and implemented -- begun to implement an array of preventive and response programs.

I think it's important to note for the record -- and hope that this gives some reassurance to the American people -- that unlike other crises we have faced, pandemic flu is a threat that our federal government anticipated and planned for. Nearly two decades ago, in 1992, the Institute of Medicine warned that emerging microbial diseases were a serious threat, and that a number of modern demographic and environmental factors would facilitate a rapid spread.

We have seen since then global outbreaks of avian bird flu, West Nile virus, SARS and a host of other infectious diseases.

In response, in the early '90s or mid '90s, the CDC developed a national emerging infectious diseases strategy and President Clinton issued a presidential directive for federal agencies to begin a coordinated national response to the growing threat of infectious diseases.

But in 2003, we experienced a particularly bad seasonal flu outbreak and a particularly inadequate governmental response. After that, President Bush himself issued presidential directives and in 2006, the Homeland Security Council issued a national strategy -- agreed on and issued a national strategy for a pandemic influenza implementation plan, which sets out a detailed road map for what to do in a crisis such as the swine flu outbreak we are in now.

States, supported by grants from the Department of Homeland Security and HHS, have pursuant to that plan developed their own plans for addressing pandemic flu. In fact, state and local governments have gone through demonstration or preparedness exercises for exactly what we're going through now. But that doesn't mean that we don't have a lot of work yet to do and that we don't have to remain very prepared, ready and agile, because we are facing a disease here whose course really is unpredictable.

This morning, we on this committee are going to ask and hope that our witnesses will be able to answer some of the tough questions that remain on the minds of our constituents and on ours as well. And we look forward to your answers to those questions.

Again, I thank you for what thus far has been a very strong and a very reassuring response to a very real public health emergency.

Senator Collins.

SENATOR SUSAN COLLINS (R-ME): Thank you, Mr. Chairman.

Mr. Chairman, all of us are extremely concerned about the human swine flu outbreak that continues to grow in our country and around the world. While the disease has thus far been confined to six states, it is likely to spread further in the days to come. As the chairman mentioned, more than 150 people in Mexico are believed to have died from the virus. And just this morning, the first death in our country was confirmed by the CDC. There's also the dangerous potential that the flu strain will mutate into an even more deadly strain or one that is even more infectious.

The American people have the right to expect that the federal government is doing everything possible to combat this potential pandemic. And to date, I would agree with the chairman that it appears that our federal officials have taken this threat very seriously and responded very effectively. Today's hearing will give us the opportunity to learn more about what the federal government has done and what it plans to do to meet this growing public health threat.

As the chairman mentioned, on Sunday the Department of Health and Human Services declared this incident a public health emergency. That alarmed many in the public. But as Secretary Napolitano has carefully explained, that was necessary to allow for the release of federal resources to support our preparedness and response efforts. It also gives agencies greater flexibility to put rapid measures in place, should the flu virus become an even more prevalent threat.

The declaration also places the Secretary of Homeland Security in charge of the overall federal government's response. Consequently, DHS must work closely with HHS and its component agency, the Centers for Disease Control and Prevention, in shaping our response. And I look forward to hearing the testimony of our witnesses today.

Congress has provided authorities and funding to strengthen our nation's ability to respond to a pandemic incident, including the establishment of the Biomedical Advanced Research and Development Authority or BARDA at HHS. I strongly supported the creation of BARDA and the increases to its funding.

To date almost $7 billion has been appropriated for federal pandemic preparedness activities.

This funding has been used for stockpiling antiviral drugs for the treatment of more than 50 million Americans. It has been used to license a pre-pandemic influenza vaccine, to develop rapid diagnostics, and to complete the sequencing of the entire genetic blueprints of more than 2,000 human and avian influenza viruses.

I mention that figure -- it's actually 2,250 -- because it shows how many strains of flu we're already dealing with. And yesterday the president asked for an additional $1.5 billion to combat this disease as part of the supplemental appropriations bill that Congress will soon be considering.

Despite these authorities and this funding, this committee has uncovered weaknesses in pandemic flu planning and coordination in the past. Just last year, our committee held a hearing on mass medical care that would be needed in the response to a pandemic flu or the detonation of a terrorist nuclear device. This hearing revealed some serious gaps in the nation's capacity to provide mass care if thousands were to become ill.

The committee has also held a hearing on HHS's development and procurement of the necessary vaccines, drugs and counter-measures for public health emergencies just like this one. In addition, we previously looked at the poor communications and coordination between DHS and the CDC in an incident involving a Mexican citizen with multiple drug-resistant form of tuberculosis who was able to enter our country 21 times after being identified by the CDC.

These incidences lead us to several important questions that we will explore today. What has the federal government done thus far to protect the American people from this potential pandemic? Since the Department of Homeland Security has put relatively passive inspection techniques in place at the border, should more be done to protect against cross-border spread of the disease? How are the plans working? And have we encountered any unanticipated problems? What role should the state and local health departments play? What is the role for hospitals? I met with 21 hospital administrators from Maine yesterday, who talked about the number of inquiries that they are fielding about this disease.

I particularly look forward to hearing about the status of the federal government's pandemic planning efforts. A critical part of this planning is the antivirals and other medical countermeasures from the strategic national stockpile that must be distributed rapidly to the public when needed. I would like to have more information on how that distribution is working. Is it getting out to every state? How are the priorities set?

As the previous hearings in this committee's investigation into the Mexican national with TB highlighted, coordination between DHS and HHS is essential, as is communication with Mexican officials. These are issues we'll be exploring today as well.

Finally, let me indicate that I have been concerned about how the lack of appointees at top positions at HHS and DHS may be hindering the response. I'm sure that HHS has been handicapped by the absence of a secretary, and I'm pleased that the Senate finally voted last night to confirm Governor Sebelius's nomination. But we still don't have a permanent head of the CDC, and DHS -- though we have many very capable individuals from the CDC -- and DHS still lacks a chief medical officer.

I mention this because effective leadership is so important to the effectiveness of our response. And in this regard, I'm very pleased with the leadership that has been shown so far.

Thank you, Mr. Chairman.

SEN. LIEBERMAN: Thank you very much, Senator Collins.

And now we'll go right to the witnesses, again with thanks for your accommodating, moving your schedule to be here with us today. Secretary Napolitano, thank you.

SEC. NAPOLITANO: Thank you, Mr. Chairman, Senator Collins, members of the committee. Thank you for the opportunity to testify on the national response to the H1N1 flu outbreak. This is, as you have noted, a serious situation that we are treating aggressively. As President Obama said yesterday, it is a cause for concern but not for alarm.

There is a lot we don't yet know about this outbreak. But we have been preparing as if we are facing a true pandemic, even though we don't know the ultimate scope of what will occur. We also have been preparing with the understanding that this will be a marathon and not a sprint. We're going to be at this for a while.

Mr. Chairman, as you noted, the secretary of Homeland Security is the principle federal officer for domestic incident management, including outbreaks like this one. Under that role, we have been leading a true collaborative effort.

HHS and the CDC also have lead roles on the health and science aspects of this outbreak. But every department of the federal government or virtually every one has a role to play.

For example, the Department of Education already has had a conference call with 1,400 participants on how to report, identify and prevent H1N1 in school facilities.

The United States Department of Agriculture has been working to reassure people, on the safety of our pork and pork products, and to work with other countries, with respect to the import of our pork products. The United States trade representative I was with yesterday is doing the same.

As you noted, our state, local and tribal partners are absolutely indispensable because on many questions, they actually have the lead role. They are the first responders.

We are now at the Department of Homeland Security conducting daily conference calls with these partners. Some days, we've had as many as 48 states participating. We have 40-plus states participating on a regular basis.

And indeed the public has a role to play here and a responsibility, a responsibility to cover our mouths when we cough, a responsibility to wash our hands regularly and, if you are sick, not to go to work, not to get on a plane or a bus, if your child is sick, not to send them to school, to avoid infecting others.

I'm pleased to be here with Rear Admiral Anne Schuchat from the CDC. I want to commend the CDC and their work on this. They have been absolutely phenomenal to work with here and educating all of us, about this particular strain and about flu outbreaks in general.

The career public-health officials there are doing a terrific job, as are the career officials at the Department of Homeland Security. And I want to praise them as well.

As you noted, part of the preparation is analyzing what we have, with respect to antivirals. The national stockpile has 50 million courses. And we are releasing 25 percent of the state portion already.

Senator Collins, you asked about who has -- who has been delivered already. Indiana, Nevada, Kansas, Kentucky and Ohio have received antivirals from the stockpile today. Antivirals are on their way to Arizona, California, Texas and Utah. And I'd be happy to supply the other schedule for the delivery. But that's the status as of this morning.

We have placed priority on states with confirmed cases of H1N1 and of course with the southwest border. But all states will ultimately get resources. And we intend to have complete delivery by the 3rd of May.

The State Department is also --

SEN. LIEBERMAN: Excuse me.

That would be complete delivery of the 25 percent, not of the full --

SEC. NAPOLITANO: Correct, correct, Mr. Chairman.

SEN. LIEBERMAN: Thanks.

SEC. NAPOLITANO: The State Department also has been involved with the CDC. We have issues travel health alerts and travel warnings for non-essential travel to Mexico. And I anticipate those warnings and alerts will be up, until the public-health officials tell us they no longer need to be.

Our actions are being guided by science and by what the public health community is telling us.

In addition, with respect to the Department of Homeland Security, we are moving forward in accord with planning and frameworks that had been worked on for several years. At the land ports and at the airports, CBP, Customs and Border Protection, is monitoring incoming travelers for possible H1N1 flu symptoms. Those who appear sick are put in separate rooms, to be evaluated by health officials. The TSA also has protocols, similar protocols, for air travelers who appear ill. And the Coast Guard is working with shipping companies with respect to possibly ill crew members.

The travelers' health advisory notices made by the CDC tell travelers about the H1N1 flu, what to do if they have symptoms. And CBP is distributing tearsheets, cards, at the land ports and to those coming in on planes from Canada and Mexico. We're also distributing materials to passengers on cruises that stopped in Mexico. And of course, TSA is posting all of this information at airport checkpoints.

The actions at the border are consistent with and match the recommendations of the CDC and the World Health Organization. And here I want to pause a moment. There has been some question raised about closing the borders. And first, the actual statutory authority is not with respect to closing an entire border; it's with respect to closing a particular port or series of ports. But I think, as Admiral Schuchat will explain in greater detail, making such a closure right now has not been merited by the facts; would have very, very little marginal benefit in terms of containing the actual outbreak of virus within our own country.

As I mentioned, our coordination with state and local partners is very robust. We are also coordinating with our international partners and with the private sector. I have been in phone contact with the governors of many of the states, and I'll be making another series of calls this afternoon. I have spoken with my direct counterparts in Mexico and Canada. We have adopted in many respects a trinational approach to this, because the virus itself doesn't know when to stop at a border or not.

And the Private Sector Office and the Infrastructure Protection Offices of the department are working with the private sector, really informing them that it's time to dust off their pandemic flu plans, if they haven't exercised them, to get them ready, and really to focus on business continuity planning as we move forward.

Within the department we are working to prepare the health of our own employee. We are -- employees. We're pre-positioning antivirals as well as personal protective equipment in case those are needed. And we continue our operations in full force.

Let me conclude with this. Every American has a responsibility here with this outbreak. Every community has a responsibility to work on and get the word out about preparedness.

Obviously our thoughts, prayers, sympathies go out to the families already affected by this H1N1 virus, but our goal is to make sure that the country is prepared, that we respond with alacrity and with efficiency to the current outbreak.

Thank you, Mr. Chairman.

SEN. LIEBERMAN: Thanks, Madame Secretary, for an excellent opening statement.

Admiral Schuchat, thanks to you and your colleagues at CDC for your service all the time, but really for your very impressive ability to communicate facts to the American public at this time, which are most important.

Please proceed.

ADM. SCHUCHAT: Thank you. Good morning, Chairman Lieberman, Ranking Member Collins and other distinguished members of the committee. I'm Dr. Anne Schuchat, the acting deputy director for CDC's Science and Program. I appreciate the opportunity to join the secretary and to tell you about the currents steps of what's going on and what we're doing about it.

Our hearts go out to the people of the communities in the United States, in Mexico and around the world who are coping with this challenge, and I think all of us this morning are thinking of the family in Texas who did lose a loved one.

People are concerned, and we're concerned as well. We are responding aggressively at the federal, state and local levels to understand the complexities of this outbreak and to implement control measures. Our aggressive actions are possible in many respects because of the investments and the support of the Congress and the hard work of state and local health officials at the front line across the country.

Flu viruses are extremely unpredictable, making it hard to anticipate the course that this outbreak will have with any certainty. We do expect increases in the number of cases, the number of states that are affected and the severity of illness. In this uncertainty, we hope that we can remain clear in communicating what we do know, what we're doing to protect the health of Americans and help Americans understand the steps that each one of us can take ourselves to protect ourselves, our families and our communities.

Influenza arises from a variety of sources, and in this case we've determined that there is a novel 2009 H1N1 virus that's circulating both in the U.S. and Mexico that contains genetic pieces from four different virus sources. Additional testing is under way on this virus, including the complete genetic sequencing.

CDC has determined that this virus is contagious. It's spreading from human to human, similar to seasonal influenza, likely through coughing and sneezing.

Sometimes people may become infected by touching something with the flu virus on it and then touching their mouth or nose. But there's no evidence to suggest that this virus has been found in swine in the United States, and there's been no illnesses attributed to handling or consuming pork. There's no evidence that you can get this new influenza virus from eating pork or pork products.

I want to reiterate that as we look more intensively for cases, we are finding more cases. We fully expect to see not only more cases, but also, potentially, greater severity of illness.

The specific numbers are really less important in understanding the outbreak than the more general patterns that we use to help guide our intervention.

Aggressive actions are being taken. They're being taken here and around the world. We're working very closely with the state and local public health officials in the U.S. on the investigation to implement control measures. We're providing both technical support on the epidemiology as well as the laboratory support for confirming cases. We're also working with the World Health Organization, the Pan American Health Organization, the governments of Mexico and Canada on really understanding and responding to this outbreak.

There's a tri-national team that's working in Mexico, including members from CDC, to better understand the outbreak and enhance surveillance and lab capacity, so that we can answer critical questions such as why the cases in Mexico appear to be more severe than the initial ones that were seen in the U.S. We're working closely with Secretary Napolitano and other federal partners to ensure that our efforts are coordinated and effective.

CDC has issued numerous health advisers -- advisories, for individuals, health care practitioners, schools and communities. And these continue to evolve as our understanding of the situation changes.

On Monday CDC issued a travel health warning for Mexico, recommending that travelers defer nonessential travel to Mexico. We're also evaluating information from other countries and we'll update travel notices as necessary. But as always, people with flu or flu-like symptoms should stay at home and not attempt to travel. In fact a key message from us is that there's a role for everyone to play in this outbreak. At the individual level, it's important to understand how each one of us can help prevent respiratory infections. Frequent hand-washing is effective to reduce transmission of disease. If you're stick -- sick, stay home. If your kids are sick, have a fever and flu-like illness, they shouldn't go to school.

And if you're ill, you shouldn't get on an airplane or a public transport to travel.

So taking personal responsibility for these things will help reduce the spread of this new virus, just as it helps reduce the spread of other respiratory illnesses.

It's important for people to think ahead about what each one of us would do if this outbreak deepens in our own communities. Communities, businesses, schools and local governments should plan now for what to do if cases appear where you live or work. For example, parents should prepare for what they would do if faced with a temporary school closure. Do you have all your plans in place?

We also have issued additional community guidance to clinicians, laboratory workers, other public health officials so that they know what they should do if they see cases in their community. All of these specific recommendations, as well as other regular updates, are on our website, www.cdc.gov.

CDC maintains the nation's Strategic National Stockpile of medications for the eventuality that they may be needed in a situation such as we face. As part of that pandemic preparedness effort that the senator was speaking, the U.S. government purchased extensive supplies of antiviral drugs, and our preliminary testing is reassuring that the virus that's circulating can be treated with the drugs that are in our stockpile. That's a really good thing.

We have released one-quarter of the states' share of the antiviral drugs and personal protective equipment to help states prepare to respond to the outbreak. We also, working with the FDA, have achieved an emergency use authority to facilitate the effective use of some of these materiels. Distribution has begun, starting with the states where we already have confirmed cases. And the Department of Defense and individual states have also stockpiled these antiviral drugs.

Whenever we see a novel strain of influenza, CDC begins work toward the development of a vaccine in case one is needed to be produced. CDC worked to develop what we call a vaccine seed strain that's specific to this novel virus, which is the first step in vaccine manufacturing. We've initiated steps so that should we need to make a vaccine as a government we can work towards that goal very quickly. Rapid progress will be possible through the combined efforts of CDC, NIH, FDA, BARDA and, of course, the manufacturing community.

Finally, it's important to recognize and acknowledge that with the strong support of the Congress there have been enormous efforts in the U.S. to prepare for this kind of outbreak and to prepare, really, for pandemics in general. Our detection of this strain in the U.S. came as a result of that investment. Our enhanced surveillance and laboratory capacity are critical now in understanding and mitigating this threat. While we must remain vigilant throughout this and subsequent outbreaks, it's important to note that at no time in our nation's history have we been as well prepared as we are today.

As we face the challenges in the weeks ahead, we look forward to working closely with Congress to best address this evolving situation. And I look forward to answering your questions.

SEN. LIEBERMAN: Thanks very much, Admiral. That was very helpful. I appreciate what you've said, and I agree with you, (though/that ?) we're fighting a serious public-health challenge and we don't know now exactly what path it will follow.

And I want to paraphrase what you said: At no time in our nation's history have we been better prepared to deal with exactly this kind of crisis. And I appreciate what all of you at CDC do to put us in that position.

We're going to have seven-minute rounds of questions for each senator, and I'll begin now. Let me ask you a few of the medical questions. You're right, we're fortunate to have 50 million doses -- is that the right term?

ADM. SCHUCHAT: It's actually courses, the full course, yeah.

SEN. LIEBERMAN: Courses, right, of treatment -- of two drugs, I gather, Tamiflu and Relenza, both of which have been found to be effective. And this is treating swine flu if it occurs.

Do you think now that the 50 million courses are adequate to the need? And if not, what should we be doing both on your end and on ours to finance increase of that inventory?

ADM. SCHUCHAT: The estimates of how much was needed for the strategic national stockpile involved a mixture of federal and state responsibilities. And our planning assumptions were to make sure that we had enough antiviral medications to treat 25 percent of the population.

SEN. LIEBERMAN: Right.

ADM. SCHUCHAT: We have -- among our 50 million doses, there are 6 million that are designated for strategic priorities, things like containment, should that have been possible. And I think we're reevaluating the issue of whether additional antivirals may be needed in the future. We are so fortunate that we made those investments and that, with the coordination and planning, we've been able to deploy those -- the 25-percent portion of the assets. We don't really know if we're going to need to use large numbers of them, but I think we're ready if we do.

SEN. LIEBERMAN: There's a feeling in response to some of the things that experts like yourself have said that it's possible that the current outbreak will diminish as what we have come to call flu season ends, but then may pick up again much -- in a much greater way next flu season, later this year. Is that accurate? Do we know that with a reasonable certainty? Or is it possible that the swine flu will just keep on expanding and going further?

ADM. SCHUCHAT: You know, unfortunately, influenza is very unpredictable. Seasonal flu has a fairly clear season and really goes away in our summer months. And in pandemics that have been studied in the past, sometimes there have been second waves -- you know, one spring and then a second wave the next fall or winter. So we don't know what pattern we'll see, whether cases will continue to increase or whether there'll be a decline.

What we'd like to communicate is that, if we do see a decline, that doesn't necessarily mean we're out of the woods. We need to be planning and preparing for an eventual recurrence. And that's part of the thinking involved with the vaccine discussions that we're having right now.

SEN. LIEBERMAN: Right. And again, I'm sure the public understands this. We're talking about two things. We're talking about the antivirals, which are a treatment for people who come down with swine flu; and then we're talking about trying on a really aggressive schedule to develop a vaccine which, hopefully, would prevent the flu from spreading.

ADM. SCHUCHAT: Yes, that's right, Senator. The antiviral drugs or medicines, like Tamiflu and Relenza --

SEN. LIEBERMAN: Right. Right.

ADM. SCHUCHAT: -- can treat an influenza illness. We have influenza vaccines that we use every year to treat the seasonal flu. And we're discussing across government and the scientific community the issue of developing a vaccine specific to this new influenza virus that's been detected.

SEN. LIEBERMAN: I know that President Obama has requested an additional $1.5 billion to be prepared to deal with this. I presume that a good amount of that money is meant to be available for either acquiring more antiviral courses and investing in the development of the vaccine for the next flu season. Is that right, secretary?

SEC. NAPOLITANO: Yes, Mr. Chairman. And I think it is a rough estimate, that we just want to have a pool of money, as it were, that could be drawn down -- drawn down quickly.

SEN. LIEBERMAN: Okay. Let me ask you now one of the questions that my constituents, at least, ask me, which you touched on in your opening statement, which is this. Since this swine flu outbreak began in Mexico and a lot of the stories we're hearing in the media about people who seem to have it, including now some suspected cases in Connecticut, more often than not, certainly in a disproportionate number of cases, involve people who visited Mexico or had some contact with somebody who did -- so the question is, why not, within the terms that you describe, statutorily close the border? And both ways, both people coming from Mexico to here, or Americans -- in other words, why not just say, no, you can't go to Mexico from the U.S. for some period of time; not just have a travel advisory?

SEC. NAPOLITANO: Well, I'm going to ask Dr. Schuchat to respond, because we have been taking our guidance there from the public health community --

SEN. LIEBERMAN: Okay.

SEC. NAPOLITANO: -- as to when the facts merit actually closing a port. Our number-one issue is what is the best thing to do for the safety of the American populace, but --

SEN. LIEBERMAN: Admiral, go ahead.

ADM. SCHUCHAT: Yeah, thank you. You know, this is a reasonable question that people are asking, and we want to make sure we get clear information out. There has been a formal policy analysis of this issue, including analysis with infectious disease modeling. And the estimates are that --

SEN. LIEBERMAN: Was this done now or --

ADM. SCHUCHAT: 2007 this effort was carried out.

SEN. LIEBERMAN: Okay.

ADM. SCHUCHAT: And there have, of course, been updates as new information comes along, with just that idea of would it be effective to -- you know, to try to close or partially close the border.

And the estimates were that if there were cases in Canada or Mexico, within days, the ability to stop that introduction into the United States would be gone.

So given -- what we're -- have been doing is really looking at the epidemiologic patterns, the spread of disease where it's occurring. And the scientific assessment is the most effective strategy right now is to focus on where we have illness, those families in the communities around them, and that it's really not an effective approach to try to block things at the border.

Of course, we have our efforts to suggest to travelers to the U.S. to defer nonessential trips to Mexico. And we have a strong partnership with the customs and border protection staff to recognize ill passengers and -- or travelers and deal with them.

There's a personal responsibility element in all of this, in terms of when each of us is ill not getting on an airplane or crossing a border. But we really think -- and, in fact, the director-general of the World Health Organization has said at this point the most effective assets really need to be focused elsewhere and the border is a real diversion.

SEN. LIEBERMAN: Let me just follow up -- my time is ended, but real briefly, because the follow-up response from my constituents to the answer that I think I heard you give, which is the virus, swine flu is already here so we got to contain here and closing the border or stopping people from going to Mexico or coming from Mexico to here doesn't help at all, their response to that is, well, the more people who go back and forth between Mexico and here, isn't it more likely that there will be more contagion occurring? What do you say to that from a medical point of view?

ADM. SCHUCHAT: Yeah. From a medical point of view, I think that's not the case. I think it's reasonable for people to be asking that question, but that's where that infectious disease modeling goes on, that, you know, we have infectious cases or confirmed cases in many communities in the United States, so the probability of exposure from someone who has no contact with Mexico is also an important issue right now. So I think it's reasonable that they're asking, but we don't think that's a good strategy.

SEN. LIEBERMAN: Okay. I'm sure that others on the committee will want to continue this discussion. My time's up. Thank you.

SEN. COLLINS: And I will.

SEN. LIEBERMAN: Senator Collins. It's all yours.

SEN. COLLINS: Madame Secretary, you've explained, as has the doctor, why you don't think the border with Mexico should be closed. But there are other steps that could be taken to enhance the screening at the border.

Now, last year, Customs and Border Protection inspected almost 400 million travelers coming across our border. So we're talking about a very high volume.

And as I understand it, DHS has instructed the border officials to use passive surveillance at our ports of entry to try to identify individuals who could have symptoms of the flu.

But other countries are being far more aggressive in their screening. Singapore, Thailand, Japan, Indonesia, South Korea and the Philippines are all using thermo -- thermal scanners. Those were also used during the SARS crisis in 2003 at airports. And as I understand it, these screeners -- these scanners are able to detect if a passenger has a fever, and then the person can be set aside.

Now I heard you on television say that you didn't think the technology was good enough, but in fact we have half a dozen countries who are employing that.

It seems to me that there are steps that could be taken to strengthen the screening at the border if closing the border is neither practical nor called for according to the public health assessment. Why aren't we doing more to try to screen?

SEC. NAPOLITANO: Senator, thank you.

Actually, the term "passive surveillance" is really not an accurate depiction of what is going on. What our CPB officers are doing is actively monitoring travelers that are attempting to cross the border, asking for those who appear ill; asking, you know, questions about whether they are ill, their travel history and the like. And there's a protocol that is in place for how that is done.

We take our guidance, as I said before, from the public health officials as to what steps really would work and would be effective.

With respect to the thermal scanners, they are not always accurate. I mean, this is not -- they are not always as precise are one would wish, but in addition, you have travelers who actually have the flu who don't have a temperature. So they're -- they don't really help you sift out travelers who are ill from those who are not.

And so the recommendation to us has been that that would not be a particularly useful technology.

I don't know if the admiral has anything to add there.

ADM. SCHUCHAT: Yeah, that's exactly right. Some countries are doing this now, and of course during the SARS experience this was done quite a bit. The science right now really doesn't hold that up. You know I was personally scanned many times during the SARS issue, when I was in China. But I think that we're really trying to follow the science here.

SEN. COLLINS: I guess my concern is that even if that technology is not perfect, even if the individuals who have the flu don't necessarily have a fever at the early stages, it seems to me using technology to try to identify some of the individuals would make sense. And if you have six other countries doing that, then clearly there must be some value in identifying individuals who have fever, since that is a common symptom, who could be set aside for additional screening.

It's -- it just strikes me that -- and maybe "passive" is the wrong term, as the secretary suggests -- but in fact the reports that we're getting is that the volume is such that it's very difficult for officials at the border, who are not medically trained, after all, to do this kind of selection process or surveillance. But -- Doctor?

ADM. SCHUCHAT: You know, I just want to make sure that I'm clear. We are looking at the pattern of illness that we have here in the United States and the many places within in our own borders where there are now laboratory-confirmed cases and what that tells us about our risk within the U.S. And I think much of our attention comes from previous outbreaks and modeling and such, and really suggests that the focus is really in the -- in looking aggressively for cases here in the U.S., responding in our own communities.

And so I think it's understandable for there to be questions about this and the issues in countries that have not yet seen cases may be quite different. But here in the U.S. we're really focusing on what we can do within our own communities where we are -- we have several states with active cases.

SEN. COLLINS: Doctor, let me ask you a more fundamental question. I believe that most Americans would be surprised to learn that 36,000 people every year die from the regular seasonal flu and that regular seasonal flu produces some 200,000 hospitalizations.

Those statistics were surprising to me, and I suspect that they would be to most Americans.

What makes this particular strain of flu particularly dangerous and alarming?

ADM. SCHUCHAT: You know, this situation that we're experiencing now reminds us that seasonal flu is a bad thing -- also, as you say, the 36,000 estimated deaths. And we make intense efforts to try to protect people from seasonal flu.

The difference right now is that we are dealing with a novel virus. We don't know yet all of the characteristics of how it will behave in human populations. But we know that it's a virus that hasn't been around before, that our -- we haven't seen immunologically. So what we think is that the general population doesn't have immunity to this virus. With seasonal flu, a good proportion of the population has some immunity because of the viruses that circulate every year, and one of the risks for future pandemic potential is a new virus that there really isn't widespread population immunity to.

We're actually trying to understand now whether some people who are older, seniors, might actually have some protection, some natural immunity against this particular virus, because perhaps it's close enough to things that were circulating a long time ago. But we really worry about that novel strain that isn't like the circulating seasonal flu strains.

SEN. COLLINS: Thank you.

Thank you, Mr. Chairman.

SEN. LIEBERMAN: Thanks very much, Senator Collins.

Senator McCain?

SEN. JOHN MCCAIN (R-AZ): Thank you, Mr. Chairman. And again, I want to thank Secretary Napolitano and, Admiral, you also, for doing a fine job in keeping the American people informed, coming here and testifying, appearing on national television. This is something that has really got Americans deeply concerned, and understandably so. And thank you for your continued communication with the American people.

Madame Secretary, if we close the border with Mexico, that obviously -- you have the responsibility to make that recommendation. I would imagine it'd be a presidential decision. And you said that conditions right now do not warrant a closure of the border. What conditions would warrant -- what conditions would warrant that you would recommend that the border between the United States and Mexico be closed?

SEC. NAPOLITANO: Well, if the CDC told us that closing the border would have a significant impact on the prevention of disease within our country, I think that would be a highly relevant factor. But the analysis has been that we would -- closing ports, closing the border would not have that kind of preventive impact at this stage.

ADM. SCHUCHAT: Yeah, and I'd actually like to add to that. You know, some of the planning that we have been doing over the years past had the -- the primary assumption that a new strain of influenza was going to come from very far away. We were worried about the H5N1 bird flu strain of influenza, and we wondered, if we see illness, you know, in a very distant place, what should be our posture. But we also --

SEN. MCCAIN: But I -- I say with some respect, Admiral -- and I don't have much time -- if we're not going to close the border because the conditions don't warrant it, what conditions DO warrant the closure of the border?

ADM. SCHUCHAT: What I'm trying --

SEN. MCCAIN: Are there any conditions that would exist that would -- for example, the EU is just recommending that there be no flights from Europe to Mexico. And I would imagine that the -- that there will be reciprocal action.

I think the American people need to know, if we don't have to close the border now -- and with all due respect, we all know, Madame Secretary, the millions of people that move back and forth across the border on a daily basis. And just observing them I don't think is -- certainly not totally effective, to say the least.

What conditions would prevail that would say we need to close the border between the United States and Mexico, if any?

ADM. SCHUCHAT: I don't think there are any.

SEN. MCCAIN: You don't think there are any.

I thank you. And by the way, I think it's appropriate, again -- and I know you have been -- as Senator Collins pointed out, 36,000 people do, tragically, die every year from the flu that we experience in this country.

What do -- what do you think the percentages are, Admiral -- that likelihood that it tails off, as you said in your prepared statement, during the summer, but then it -- we find a recurrence takes place when flu season begins again?

ADM. SCHUCHAT: You know, unfortunately, we really can't predict exactly what's going to happen. There are many things that we'll be doing to try to understand this -- the probability that there'll be additional -- another wave.

There are issues like looking in the Southern Hemisphere, at the pattern of disease that they have. We can also do some things to try to understand our population's immunity. Did we already see this new strain go through a lot of the population? And we developed some protection.

So there has been planning, in terms of the research and the epidemiologic studies, that could help us better predict. But even with all of those, we won't be able to perfectly predict. So our posture is to prepare and to be ready, if things do get worse.

SEN. MCCAIN: Is it possible, given your experience, to tell me your personal prediction?

ADM. SCHUCHAT: My personal prediction is that I will get in trouble if I make a guess. (Laughter.)

SEN. MCCAIN: Well, that's a good point.

Madame Secretary, the admiral's point about no conditions warranting closing the border is a very important one. Then if that's the case, I really hope that we would pursue vigorously better technological and scientific and frankly closer observation of people going across the border than is presently the case.

And I know that we have a huge border with Mexico. And it would be hard to implement immediately. But if the possibility is that we may be in for the long term here, as the admiral, I think, very appropriately refuses to predict but is a possibility, then we ought to look at ways of checking people more carefully, as they go across the border, between the United States and Mexico.

And I know, you know, that the report of the first death from swine flu, in the United States, just took place in the State of Texas. So I think we need to, and I believe you are, maintain a careful balance between not causing panic out there, amongst the American people, but at the same time making them aware of the implications of this threat, much of which is really not totally known to us.

But we have experienced SARS and other viruses in the past and have been able to gain some control. Does the present vaccine, Admiral, that a lot of Americans routinely get, have any beneficial effect on H1N1?

ADM. SCHUCHAT: Based on the studies that have been done so far, of this new virus, we don't expect there to be protection. There are some additional things that we're looking at, to understand whether our pessimistic prediction might be wrong, and in particular looking at serum from certain populations, to understand whether there might be any cross-protection. But based on the laboratory testing that's been done so far, we don't expect there to be any cross-protection.

SEN. MCCAIN: In a best-case scenario, how long would it take us to discover and develop a vaccine that would combat H1N1.

ADM. SCHUCHAT: There are active efforts right now. We have -- at CDC, our role is to develop the vaccine strain that is handed off to industry. The steps after that would be pilot lot development, finding that manufacturing, and studies really undertaken, by NIH and FDA, to make sure that we know how to make the vaccine, the dosing, and whether or not you need what's called adjuvant, to increase the immune response.

If everything went great, production could lead to availability as early as September. But of course with influenza vaccine production, even seasonal flu, everything doesn't always go great.

So there are lots of entities meeting and taking steps, to aggressively move forward in being ready to produce a vaccine, should we need to. But even with the best case and decisions made quite promptly, we wouldn't have product until the fall.

SEN. MCCAIN: Madame Secretary, I hope you'll keep revisiting this issue, of whether we need to close the border or not.

I thank you, Mr. Chairman.

I thank you all for your fine work.

SEN. LIEBERMAN: Thanks, Senator McCain.

You know, I must say, I didn't come here this morning feeling, and I still don't, that we have to close the border with Mexico. But I'm surprised at your answer, Admiral -- in my second round, I'll ask you more questions about it -- that you can't foresee a circumstance in which we would possibly want to do that.

My own feeling -- I'm not a doctor, to say the obvious -- is, if we can contain the spread of the flu here, that one thing we might want to do, just as the Mexican government is thinking about stopping public gatherings, even in the worst case closing down parts of the business sector in Mexico City, because they don't want it to be communicated, is it kind of common sense that says, well, if it reaches that point, don't we want to avoid increasing the probability of contagion, even for a temporary period of time?

I understand there would be horrendous economic and personal effects of this, on both sides of the U.S.-Mexican border.

And of course, in this death that occurred today in Texas, this child apparently went from Mexico to Texas, so presumably there was some connection there.

SEC. NAPOLITANO: Mr. Chairman, first of all, you're right. And this situation keeps changing. For example, the CDC is going to announce that four other states now have confirmed contagion: Arizona, Nevada, Massachusetts and Michigan. And they're going to announce now 91 confirmed cases. We can anticipate that that -- those sorts of reports now are going to continue.

But the decisions about closure of events -- you know, closing a school, not having a meeting, that sort of thing -- those primarily are generated at the local level based on the circumstances and environment at the local level. We are working -- that's why it's so important that we work with cities and states in terms of their own implementation of their criteria for when they would close or not close, and again, needs to be informed by the science, the extent of contagion, what you can prevent by making a closure.

And returning to Senator McCain's question, obviously we will watch those ports of entry very, very closely. And I will be happy to share with you the protocols that have been given to our CBP officers of what exactly they are supposed to be doing at the ports.

SEN. LIEBERMAN: Thanks, Secretary. I just hope that -- I understand that you're giving your best -- you're not a political person -- you're giving your best medical advice and we ought to give it respect, but I hope we'll keep open, as we watch the course of this disease, the possibility that we might want for some period of time to close some of the ports of entry between Mexico and the U.S.; and if not that, then to greatly ramp up the kind of review of people going back and forth that we're doing at this point.

But I'm delaying my colleagues. Thank you for the responses.

Senator Tester, you're next.

SEN. JON TESTER (D-MT): Thank you, Mr. Chairman. And I want to thank both participants here today for their information. It's good stuff. And I think we do have a serious problem that we face, and I think it's because of -- partially because of your good work and your leadership that this will be minimized as much as possible.

I think so far the response in the country has been good from your end and from the local level and everywhere in between, and I think it's good news when all folks -- all parts of government step up to the plate and really do their job potentially to rethink their flu response plans and things like that. It's good news.

I think that the bad news is, as I think we all recognize, there are still some gaps. There are still some things we need to iron out. I come from a frontier community in a very rural state, with a border of 545 miles with Canada, in this particular case, with many ports of entry between Canada and Montana. And I think we all realize how important that those ports are. We all understand how important trade is. And we also all understand how serious this potentially could be as it starts to unfold.

But we need to make sure we take the right precautionary trail as we go forth here. Some have said we need to close the border. We've heard today that potentially is an option until this blows over. I tend to agree with the good doctor. I think that we need to let science lead the way here and make reasonable decisions, rational decisions, based on sound science, mainly because we already have some confirmed cases here in the United States and we see how it's starting to expand throughout the United States, with four more today.

We -- I should say Secretary Napolitano talked about, in your opening remarks, about what is going on on the border right now, from a perspective of the cars and trucks coming across the line, that you -- let me see, how did you put it -- you were monitoring, and the folks who look sick, you're pulling them in. What exactly do you do after that? Are they looked at by a medical doctor? What transpires there?

SEC. NAPOLITANO: Yes, Senator. They're put in an isolation room, basically. And some of our ports have a public health official right there. Other times they have to call and have one brought over to examine the individual.

SEN. TESTER: So how quick do they know if these folks have some other kind of flu or this kind of flu?

SEC. NAPOLITANO: Well, fairly quickly. I mean, I think the longest wait we've had to date has been two hours.

SEN. TESTER: Okay. What's the incubation period for this? Do you know? And this may be directed at the doctor.

ADM. SCHUCHAT: You know, this is a novel virus, so we're beginning to characterize the incubation period. And from the information we have so far, it looks to be between two and five days. But that's sort of changing as we get more information.

SEN. TESTER: Okay. In many of the rural states around this country, we have critical access hospitals that have fewer than 25 beds. Oftentimes there's a nursing home attached to them. Although I've heard that this attacks healthy adults, we see that the first confirmed death is an infant, a 2-year-old.

What can be done? What are you recommending critical-access hospitals that have nursing homes attached to them do to help stop the spread of a potential contaminant coming in, a person, to the elderly population that might be living in those nursing homes?

ADM. SCHUCHAT: You know, CDC has been issuing many new guidance documents and pushing them out to the clinical community -- the doctors and nurses, the laboratories and hospital workers -- so that they know about infection-control practices, whether -- the kinds of -- "droplet precautions" is sort of one of the terms we use, the things about how to diagnose cases, what -- where -- making sure that patients are isolated, that they won't be in a room with someone else and able to spread.

But what we are also doing is making sure that we don't get dogmatic, that we learn from what we're seeing and that we update recommendations when guidance needs to be changed because of the events that we observe.

SEN. TESTER: Okay. Can you tell me, how many confirmed cases are there in Canada? I don't know that I've read that.

ADM. SCHUCHAT: I -- unfortunately, I don't have Canada's counts myself, today.

SEC. NAPOLITANO: The last -- I'm sorry. The last I heard was several, and they were in Nova -- some were in Nova Scotia and some were in British Columbia, so they were spread out.

SEN. TESTER: Okay. Do we -- do you have the ability at CDC, or do others have the ability, to -- my guess is, if you get a group of folks that get sick, it could become bigger pretty quick. So it could infect communities -- a certain community much greater than one 150 or 200 miles away in a state. Is there -- is there agreements to be able to transfer medical personnel between hospitals or states, to make sure we have the medical personnel that can meet the need?

ADM. SCHUCHAT: You know, there are some of those agreements. In fact, during the SARS epidemic in Canada, there were American doctors that went and helped them. State --

SEN. TESTER: Is that -- is --

ADM. SCHUCHAT: State-to-state, we also have those kinds of approaches.

SEN. TESTER: Who is "we"? Is it -- is that done at the local level, or is that done at your level?

ADM. SCHUCHAT: Well, no, I think it's more at the state level.

But the issue that's important to realize, though -- in our pandemic planning, we really had to recognize that the way pandemics of influenza unfold, many communities may be affected. And so few places are likely to want to spare their professional staff, because they may be, you know, just around the corner. So this is where our guidance that -- helps clinicians know what to do even with a reduced workforce. In particular, we may see a point in the future where we have to have simpler ways to care for people -- you know, only the most sick coming to the hospital and such.

SEN. TESTER: Do you see any challenges dealing with critical- access hospitals that are going to be over and above what you would see in urban areas? And what are they? And how will you deal with them?

ADM. SCHUCHAT: What I'd like to say is that we don't know whether things will be better or worse in those kinds of communities. It may be that the more remote communities will not have the kind of problems that we're seeing in New York City, for instance. But there has -- another part -- well, there is planning on trying to sort out how the federal government can enhance what's available at the state or local level in terms of the medical surge issues.

SEN. TESTER: Okay. Thanks, Mr. Chairman. Thank you both.

SEN. LIEBERMAN: Thank you, Senator Tester. Good questions.

Senator Voinovich.

SEN. GEORGE V. VOINOVICH (R-OH): First of all, I'd like to thank both of you for the quick action that you've taken, and trying to walk that fine line in terms of making sure people have good information and at the same time not be panicked by this. I think that's very, very important.

But also, I think that we should be comforted that -- because Congress and the former administration understood how important this issue of pandemic was, that we do have antiviral drugs available to us to respond to the folks that are getting sick.

Some simple questions that people are asking: This is not swine flu; it's H1N1, I guess. Is that what we say? And we have a lot of pork producers in Ohio that have called me and have said, you know, please clarify for the public that they shouldn't stop buying pork or that countries that are having our pork exported to them shouldn't stop having it being exported. They just -- you know, it's -- said, we're hurting now, so please clarify that.

So it's H1N1, as it were, we're talking about.

The other thing is, thank you very much for your quick response to the situation that we had in Ohio. And a question I have is, because you need the help of the local officials so much, are you confident that they have the proper protocol in terms of how to identify this and deal with it? I think getting into the question of when or not you'd, say, for example, close the school -- when I was president of student body at Ohio University many years ago, I had to cancel homecoming and Mothers' Weekend, and it wasn't a lot of fun for me. (Chuckles.) But we decided that we wanted to keep folks from coming into the campus.

And you're going to have instances, I think, probably throughout the United States where people are going to take local action, and I think they need to know that the folks that are acting locally have been properly briefed in terms of just how they ought to handle this situation. Could you comment on that?

ADM. SCHUCHAT: Yes, I can comment on that. The -- we've issued community recommendations about things such as school closures and the gatherings that are associated with schools, as well as other large gatherings in a community. And what I think is important to say is that we've issued guidance that we think is prudent, that's relatively aggressive but that recognizes the role of local authorities to modify, based on the circumstances on the ground. We want to make sure every community has good information. But some of the local and state officials have even better information. So we're rushing this out to make sure everyone has guidance but that it recognizes the local people may want to do more or even less than what we say.

SEN. VOINOVICH: Now, does the communication, Ms. Napolitano, go to the governors and then down through the counties? Because usually in our state the county health officials and the city health officials are the folks that are on the ground.

SEC. NAPOLITANO: Senator, it's both. It's moving communication out to local public health officials and communication with governors and the like. So we're trying to get as much out to the relevant decision-makers as possible.

SEN. VOINOVICH: We talked about the antiviral. The purpose of that is that somebody has it and it deals with it so they don't get real sick and die.

The other part of this is the issue of vaccines, and you know, millions of Americans have taken flu shots, including George and Janet Voinovich, my wife and I, and I think that you need to clarify that because you have flu shots does not necessarily mean that you're going to be exempt from this. Is that correct?

ADM. SCHUCHAT: That's right. it's great that you've gotten your flu shot and I got mine as well. But that protects against the regular flu, the seasonal flu, not against this new virus, this new H1N1 strain.

SEN. VOINOVICH: When are you going to be able to tell whether or not folks should be vaccinated for this and at -- and also -- somebody else, I guess, asked the question how long you think it would take to develop the vaccine. And are you working with -- you're talking about CDC doing it, but are you other -- working with other world organizations so you can gather the best experts together to come up with this thing on a(n) international basis?

ADM. SCHUCHAT: Yes. CDC just has a role at the beginning in growing the virus strain and then handing it off to partner -- to make the product. We are working collaboratively both here, across the U.S. government, the FDA and the NIH -- and BARDA is really quite important -- and through the World Health Organization we're involved on a global basis. CDC's influenza experts are part of WHO's committee that picks the seasonal flu virus strains each year and that would also going forward advise about a pandemic vaccine if we needed to make such. So that's happening.

In terms of the decision to vaccinate, I'm glad that you separated the question of the decision to make a vaccine from the decision to vaccinate. Some people look back to 1976, when we had an outbreak of swine flu in New Jersey, and look -- reviewing the government response to that, wonder whether there was enough deliberation in separating the two ideas.

So what I can say is, we're working aggressively to make sure that if we need to produce a vaccine, we'll be able to -- and it could be available as soon as September 1, if all went well -- but that we also are separating that particular decision from a later decision about use of the vaccine in the fall, or when the vaccine was available. And I think that the best scientific minds will be contributing to that decision.

SEN. VOINOVICH: Right, because sometimes the vaccine in itself gets people sick, doesn't it?

SEC. NAPOLITANO: Yeah. Senator, yes. And that decision, once there is a vaccine, about who to vaccinate and how to do it is not an easy one, and it will be informed by the best scientific advice we can get.

I spent last night reading a book about what happened in 1976 with the decision-making on the last iteration of a swine flu. So we can learn from past history in terms of what kind of decision-making process we need to go through. MORE

SEN. VOINOVICH: Have you decided yet on -- in terms of who's most vulnerable? Or is it -- does it cross all age -- I mean, is it the young people are more vulnerable, or older people? Or is it just they're all about the same?

ADM. SCHUCHAT: The information so far suggests that we haven't been seeing confirmed cases in older populations, but it's early days. We have teams trying to get better information verified from Mexico. And here in the U.S., we're looking at our -- the cases we have. Our cases have a -- an average age that's quite -- quite young, you know, in the 20s or teens, not seniors. But we are also prepared to see changes, and so we don't -- we're not able to say yet the highest-risk group, but we're looking into that.

SEN VOINOVICH: Okay, thank you. Last but not least: ranking member on Appropriations, Homeland Security -- my job. And I understand you have enough money to take care of the situation now, but that you're going to be looking for money in the supplemental. Is that correct?

SEC. NAPOLITANO: The -- Senator, the president is -- announced yesterday he was going to seek 1.5 billion (dollars), and I think that is a rough estimate, and it is gauged on perhaps having to purchase more antivirals.

SEN VOINOVICH: But you've got enough money right now to hold it over? Because we don't know when that supplemental will be finally --

SEC. NAPOLITANO: Yes, sir.

SEN VOINOVICH: Thanks very much.

SEN. LIEBERMAN: Thank you, Senator Voinovich.

Senator Pryor, good morning.

SEN. MARK PRYOR (D-AR): Thank you, Mr. Chairman. Thank you for doing this.

Let me start, if I may, with you, Admiral Schuchat. And let me ask about this particular strain of flu, if you know. And it may be too early to know the answer to some of these questions, but there's a perception that it's worse in Mexico, more lethal in Mexico than it is in the United States. Is that a fair perception, or do we know yet?

ADM. SCHUCHAT: The initial impression was that confirmed cases from Mexico were severe -- hospitalized young adults with pneumonia. As the investigation in Mexico expands, apparently they are confirming illness in milder circumstances. And so I think it may -- we may yet find that truly they have a worse problem in terms of severity than we do, or that it may have just been the quality of the information early on in terms of where we were looking.

SEN PRYOR: And how -- I don't know how the process works, in terms of you determining what the mortality rate is with a particular strain of flu virus. How long does that take you, and what factors do you consider?

ADM. SCHUCHAT: Right. There's been a lot of planning around the severity index for a pandemic. Sort of like a category -- categories for hurricanes, we've been thinking of categories for pandemics, where a seasonal flu would be a category one, and a category five pandemic would be a higher-mortality situation.

We're in early days. We are looking at the illness that we see, and calculating the proportion that are fatal. But until there's a larger number of definite cases experienced, we can't precisely say things. I can say that we're acting on aggressively implementing these community guidance efforts to tamp down transmission, assuming that this is not -- you know, that this is important, that this is a serious situation that we can improve through reduced transmission at the community level.

SEN PRYOR: And I understand that flu viruses mutate. Or is it, again, too early to know whether you're seeing mutations in this virus?

ADM. SCHUCHAT: You know, it's very important that we continue to learn, that we not make all of our response efforts based on the first few isolates of virus that we tested, because it's possible that the strain will change over time. It may become more severe or less severe. It may acquire resistance, which it doesn't have right now. So we're following it. And the laboratory scientists at CDC -- you know, 24 hours a day, we have shifts working on the specimens that we have, really doing a phenomenal job.

SEN PRYOR: And one last question for you. Is the news media helping you in your efforts right now? I know there's almost like wall-to-wall coverage on this, and there's a little bit of a media feeding frenzy on this. Is that helpful?

ADM. SCHUCHAT: One of the most important things during an outbreak such as this is clear, accurate, timely communication, and the media has a very important role to play. We're committed at CDC -- and I know the Department of Homeland Security feels the same way -- to be accessible, to get information out as we know it. And the media is our partner in that. So I appreciate the help that they have given us in making sure people know what's going on.

I think they're getting tired of a few of our faces at this point, but we really do want to get our information out, and we need them.

SEN PRYOR: Good. Thank you.

Secretary Napolitano, it's good to see you again. Thank you for your public service. And I know you're doing great things over there already, and now you have this either pandemic or this at least flu episode that you're dealing with, so thank you for your service.

SEC. NAPOLITANO: Thank you, Senator.

SEN PRYOR: Let me ask you about vaccines and antivirals.

And I'm assuming that there's been a lot of preparation on how to distribute those around the country.

And you know, one of the questions I would have is, for the states, when the states receive vaccines and other materials, should they use them on their population? Or should they use them in a neighboring state that may have a worse situation?

SEC. NAPOLITANO: Well, there is a robust plan for how things like vaccines and antivirals are distributed, through the public- health community. And on this one, what we are doing is, the first states that are getting the antivirals are the ones where we already have either confirmed cases of disease or along the southwest border. But we're moving things out very quickly.

So by next week, every state will have its proportionate share. And because this is a rapidly changing picture, and every time we get a new report, there are more states that have either reported suspect cases or confirmed cases, every state then will make -- you know, will get it distributed within its own boundaries, according to its own plan.

SEN. PRYOR: Okay.

And I know it's way too early to already be putting together a lessons learned memo on this. But as early as we are in this process, are you already seeing areas where you know we can do better next time?

SEC. NAPOLITANO: Senator, it is awfully early. It's been less than a week that we've been at this. Although we've been at it, it seems, 24 hours a day. But obviously we are keeping track of what we are doing. And there will always be lessons learned from an episode like this. There are going to be things at the end that we say we would do differently. But right now, we're kind of in it.

SEN. PRYOR: Gotcha.

Well, listen, you all are both doing great work. And we appreciate you. And your -- I think both of you, as well as federal agencies, generally have done a very good job of keeping the public informed and a realistic assessment of what's going on out there. We appreciate it. Thank you very much.

SEC. NAPOLITANO: Thank you.

SEN. LIEBERMAN: Thank you very much, Senator Pryor.

Senator Burris.

SENATOR ROLAND BURRIS (D-IL): Thank you, Mr. Chairman.

I want to add my thanks to these two distinguished public servants for their prior service and current service and of course being right in the middle of the firestorm. So you have our congratulations. And we just want you all to keep up the good work.

I just, prior to coming into the committee, was on the phone with my public-health director, from the State of Illinois. And we do have eight cases that now are suspect. They are now going through the testing process. And it's primarily in Northern Illinois. So we can hope and pray that, you know, that they're not. But I don't think it looks that, you know, that promising.

Madame Secretary, I was just concerned about the challenge that we're going to have. And this flu is the treatment and the information and how you communicate. In the community of Chicago, we have about 30-plus languages that have to be spoken. And getting the word out, in all those different languages will put a strain on the resources of the city and the state.

And I just wondered if any of those dollars that the president has asked for would be some type of grant funds that could go into assisting the overall cost the states and local governments would be experiencing, during this situation.

SEC. NAPOLITANO: Senator, I think that the initial request from the president is rather general. And we're working now on how to sculpt it, to be best used, as we go through this epidemic.

So that will be a -- one of the ideas that we'll take back.

SEN. BURRIS: You know, please do, because, you know, budget's -- already's in bad shape, and -- in the cities and in state government. I know mine are operating at major deficits, and these types of crises, you know, bring additional responsibility and expenses. So it's not been budgeted for, and -- which means you're going to have to rob Peter again, and you won't even -- to pay -- you won't be able to get it from Paul, because, you know, Paul doesn't have anything either.

So please keep that in mind, that we're going to need some assistance as we try to go through the financial part of this.

SEC. NAPOLITANO: Senator, as a former governor myself, I'm very sensitive to the fiscal situation of the states and cities in the country, and what we want to make sure is that resources are put in the best place to do -- have the greatest impact. And again, all our decisions are going to be based on science and an evaluation of what is the most efficacious way to protect the safety of the American people.

SEN. BURRIS: Now, I am also agreeing with Senator Voinovich: I've been in contact with my pork producers in the great state of Illinois, and they're requesting that we come up with some other name for this influenza, or this virus, because, you know, they call it swine flu, but you always hear the reports saying it has nothing to do with swine. And so if that's the case, can we come up with a -- and what -- how do you pronounce that last name, there? "Shadach"?

ADM. SCHUCHAT: It's "Shookit."

SEN. BURRIS: "Shookit."

ADM. SCHUCHAT: Yeah.

SEN. BURRIS: Okay. Admiral, how do we come up with some other name for this -- for this -- but -- by the way, is this strain A? I thought it was strain A or something. Is --

ADM. SCHUCHAT: Right, this is an influenza A, H1N1, and for the time being we're calling it 2009 H1N1 influenza. Apparently --

SEN. BURRIS: That's not sexy. That doesn't get --

ADM. SCHUCHAT: It really isn't catchy, no.

SEN. BURRIS: (Laughs.)

ADM. SCHUCHAT: But I think -- I said before you were here that there's no evidence that eating pork or a pork product is associated with this condition. And we think that's an important message to get out, that this is not something that you get by eating pork.

SEN. BURRIS: So -- but has -- it's gotten so in the system that you can't back it off and come up with some (immediate ?) terminology? Because I'm, like -- you know, our pork producers are really concerned. People are going to stop buying. And you hear when Japan and some other countries have stopped -- it -- that was China that said they aren't -- take any American exports of pork.

Is there -- is there any -- Madame Secretary, is there any type of name we can -- I know you're not the medical expert; put on your legal hat. I mean, you were also attorney general, right?

SEC. NAPOLITANO: Yes. I've had many jobs.

And in my written testimony I -- for this hearing I just call it H1N1. And actually, once you say H1N1 a few times, it does roll off the tongue.

But I know I was with the secretary of Agriculture and the United States trade representative yesterday. We were talking about our coordinated and joint efforts to get the word out that this is not a pork-borne illness and that you cannot get it by eating pork. But I think we need to continually send out that message.

And I know the secretary of Agriculture is dealing with some countries that are using this as a purported reason to restrict imports.

SEN. BURRIS: I want to thank you all. I think that's the end of my questions. Thank you all very much.

Thank you, Mr. Chairman.

SEN. LIEBERMAN: Thank you, Senator Burris.

Senator Graham, good morning.

SEN. GRAHAM: Good morning, sir.

Can you get this from eating pork? (Laughter.)

SEC. NAPOLITANO: No.

SEN. GRAHAM: Okay. Making sure we're on message here. The opportunity to deal with this problem in terms of creating a vaccine maybe by September, is that right, Admiral? Okay. Do we have the legal protections in place that would encourage the pharmaceutical companies to develop a vaccine that fast without being sued for trying? Either one of you.

SEC. NAPOLITANO: Well, Senator, there are several protections in place. There is a public readiness and emergency preparedness act at 42 USC 237 D. And you might examine that, but that is a statute. It's guided by the secretary of HHS but designed to provide that sort of protection. That's one of the things in place now.

SEN. GRAHAM: Right. Well, from my point of view, and I would assume that most of the committee would share this, if we're going to embark on such a bold project, which it seems like it would be smart to do, we need to make sure we have the laws in place and think through what happens to those who try to help solve this problem. So as you go back and inventory the legal environment, if you find gaps or you think you need it to be beefed up in terms of providing liability protection for those to help us with this problem, please let this committee or the appropriate committees know.

Now, let's talk about the worst-case scenario for a moment, hoping it never happens. But let's just put it on the table. I guess the worst-case scenario would be that in the fall this thing spreads, that you have to consider closing the border with Mexico. Would that be one of the worst-case scenarios?

DR. SCHUCHAT: You know, I'd like to clarify my previous remarks when we were speaking about closing the border. Going forward, there's no circumstance in which I think border closure might have value. It was sort of, I think, that question of if we had no cases here and the first case was, you know, someplace far away, would a border intervention make sense.

SEN. GRAHAM: Well, let's talk about that. Let's say that we have more cases here. That we have a vaccine that works, but they don't have one in Mexico that's not working, and they keep having more cases. We're controlling the ones we have. Why wouldn't you want to consider closing the border there?

DR. SCHUCHAT: Just a few comments. I think that populations that have extensive disease are likely to be protected going forward. You know, Mexico may be in the best case going forward because this thing may have already run through their communities.

SEN. GRAHAM: Do you think that's happened in Mexico, that it's run through --

DR. SCHUCHAT: No, no. I'm just saying that if we're talking about six months from now when a vaccine might be available. But this is really a global issue and a global problem with global solutions. And the World Health Organization has been focusing on this international vaccine question and development and deployment. For us, we expect, if we went ahead and made vaccine, it would be available by the fall.

SEN. GRAHAM: Well, Madame Secretary, if I may be so bold, I can foresee a scenario where Mexico or Canada or one of our neighbors that this problem could get worse while it's getting better here, then you'd have to take some pretty drastic action. Do you have a plan in such a situation? Is there any contemplation by the administration of a plan that would indeed seal the border if it was required?

SEC. NAPOLITANO: We have plans for a number of different contingencies and scenarios. But I'll tell you, Senator, this situation really changes daily. So we will make decisions informed by science and what we think makes sense --

SEN. GRAHAM: Yeah, I'm not suggesting that you need to do that, and hope we never will, but I'm just suggesting a lot of criticism in Iraq is you always assume the best, never plan for the worst. Let's don't repeat that. We have guest worker programs, I think Senator Chambliss mentioned it to you yesterday, where we get a lot of labor in the agriculture community coming from Mexico in the H-2A and H-2B visa program. And the farmers need the labor. Where do we stand in terms of making sure that that legal immigrant population that's coming in to work here during the summer and the fall, what are we doing about that problem where we're going to bring a lot of people from Mexico here to work in agriculture?

SEC. NAPOLITANO: Senator, we really are handling the H-2A population the way we're handling travelers in general. That is to say they are monitored to see if they have any signs of disease, asked if they have any signs of disease and handled in that fashion. But otherwise, they are legal travelers because they are visaed, so they would come in.

SEN. GRAHAM: Are you doing anything new for that population beyond just what you do at the border, somebody driving a car through?

SEC. NAPOLITANO: Not currently.

SEN. GRAHAM: Do you think it would be wise to look at doing something new?

SEC. NAPOLITANO: Yes.

SEN. GRAHAM: Okay, that's fair. Now, if we have to administer immunization to the population as a whole, is that a remote possibility, Admiral in a worst-case-scenario event?

DR. SCHUCHAT: It's early days to know whether that is the type of step we would take. One of the things we try to do in this stage is learn as much as we can about who's getting sick and who isn't. And that can inform who might be --

SEN. GRAHAM: Can you see any reasonable possibility down the road, based on science, where that might be required?

DR. SCHUCHAT: Yes, absolutely. There's a --

SEN. GRAHAM: And you're planning for that, I take it.

DR. SCHUCHAT: Absolutely. That's why the past several years we've been investing in better manufacturing capacity and new technologies and so forth. So certainly, the planning cases have been whole population, two doses.

SEN. GRAHAM: Right. Now, while we have some legal protections for companies that would help develop the vaccine -- you've talked about that, Madame Secretary -- look and see if you need more. What about the people who would administer the vaccine? What about the health care professionals that would be tasked under the worst-case scenario to go out and administer this drug to the population as a whole? Do we have any liability protection for them on the books?

SEC. NAPOLITANO: You know, I'm going to need to get back with you about that. I'm not aware that that's a concern. I think the primary one had been about the manufacturers. Remember that if vaccine is delivered in this context, it would be under the federal government's authority.

SEN. GRAHAM: The only reason I mention that, being a military lawyer, we have a requirement you get vaccinated for certain problems in the military, and we had a problem with anthrax and mandatory vaccinations. We had a few cases of people that react. Well, they don't have the choice in the military because you're part of the military, that's your job. But if we do go to a mandatory immunization to the population as a whole, like we've done in the past, I think we need to really think about what exposure the health care professionals have and do something about it now before, while we have the time.

So thank you, both. I think you've done a good job. And the only reason I'm talking about this is if it gets better, that's great. If it gets worse, not so great. And I can understand how hard this is, but we've got guest workers coming in through a legal system, we've got legal liability that is there, I think in a limited way. And we need to look robustly at the guest worker program, a worst-case scenario to seal the border if you had to and certainly to look at legal protections for those who are going to produce the vaccine and administer it so that if that worst-case situation ever happens we won't be behind the eight ball.

SEC. NAPOLITANO: Senator, thank you. And I think you are right that we have to be planning for the worst and hoping for the best. The statute that I referred to does include distributors, program planners, persons who prescribe, administer or dispense.

SEN. GRAHAM: If you could send me a little memo about how detailed that is, what kind of liability protections, I'd like to talk with you about making sure that's enough and improving it if we have to.

SEC. NAPOLITANO: Thank you, sir.

SEN. LIEBERMAN: Thanks very much, Senator Graham.

Secretary, I appreciate your answer to Senator Graham's conditional question about whether you would be open to considering increasing the checks on people coming in from Mexico, guest workers for instance, with regard to their health because I think if you don't there will be growing pressure to really close the ports of entry. And I understand it's complicated with the number of -- the volume is, what, 800,000 to 1 million per day coming across. Does that sound right?

SEC. NAPOLITANO: I'll double check.

SEN. LIEBERMAN: Yeah.

SEC. NAPOLITANO: It's an awful lot.

SEN. LIEBERMAN: It's an awful lot of people. So the thought -- because really in our minds, what we'd like to think is, you know, everybody would be stopped and you'd, you know, take their temperature, you'd look at them and see if they're coughing or sweating or whatever. The Mexicans would have the right to do that to people going in if they wanted. So how we go from where we are now, which frankly doesn't sound like much and I know how hard it is, is something that will create a slightly more demanding screen for people coming in is, I think, very important to think about or I believe the pressure will grow to do something much more definitive like closing some of the ports of entry.

SEC. NAPOLITANO: Mr. Chairman, I agree. If we go to an enhanced closing the ports or an enhanced every individual gets screened protocol, we're going to have to be able to explain because that will cause delays in lines and processing. What is the advantage we're getting from that other than symbolism in terms of actually preventing disease in our country? And right now, what the scientists are telling me is, beyond symbolism, we really don't get an advantage in terms of spread of disease. But if we go that far, we are continually thinking and rethinking this. That's really the explanation we're going to have to be prepared to give.

SEN. LIEBERMAN: This is a classic of the very hard decisions when you're balancing. In fact, obviously, you've got to listen to the science. And again, commonsense would say if we're trying to stop people from congregating in places, which they're doing in Mexico already and, of course, it's starting in a couple of places here, a couple of schools are closed in Connecticut today because of suspected cases, then there's a natural next step to say, well, maybe we should then try to stop mixing the people coming over the border for the same reason. So you've got to weigh, what's the public health benefit from that? How much does it cost you to implement such a system? And then what are the economic consequences and personal consequences on our country and our neighbors in Mexico? These are not easy decisions, but if it spreads, I think we're going to be faced with those questions. And I think what you're hearing today from members of the committee is what we're not only thinking but hearing from our constituents. And I think those calls will grow louder. And you understand that.

I want to go to another subject, talk about tough decisions to make. I wanted to ask about both the antivirals and the vaccines. Here's a basic sort of uninformed-patients question about the medical consequences. Am I correct in assuming that in the case of the infant that died in Texas today, confirmed death from swine flu and almost 150 people or more now in Mexico that have died, that was because they were not administered a course of the antiviral? In other words, why do some people, apart from their own vulnerability -- and maybe that's it. Why do some people die from this and others seem to get it and go on?

DR. SCHUCHAT: Influenza is a virus that can cause severe disease, even regular flu. So each year in the U.S., about 20,000 young children are hospitalized from flu and between 50 and 150 do die with just regular seasonal flu. I don't have the specific circumstances of the child in terms of treatment. We know that antiviral drugs can improve the response, but people may die with our without them. But we do think antiviral drugs are effective at reducing the risk of that complication.

SEN. LIEBERMAN: Okay. That helps me understand it. So if we hear that people are dying from the swine flu, it's a result both of their own vulnerability and perhaps, although this would be the rare or unusual circumstance, perhaps the antiviral that they got it just didn't work or it was administered too late, for instance.

DR. SCHUCHAT: Yes, all of those circumstances are possible.

SEN. LIEBERMAN: Okay. But the probability is that if you get the antiviral treatment once you've been confirmed, you're going to get better.

DR. SCHUCHAT: The prompt treatment increases that probability. But for vulnerable hosts, sometimes the medicines aren't enough, and babies are among those at greatest risk for seasonal flu.

SEN. LIEBERMAN: Okay. So one of the judgments that you're making now, I assume, is, how many more of the antiviral courses do we need? We have 50 million, we're giving out one-quarter of them now. Am I right? You're trying to make some projection and then go ahead and purchase them with part of this 1.5 billion (dollars) the president has asked for?

DR. SCHUCHAT: Yes, that's right. We're looking into what we have on hand and what we may need going out. When we made the original estimates of how much to procure in the strategic national stockpile, it was really forward thinking in a supply-limited environment. If we have time now to produce more for the years ahead, you know, there may be some benefit in that. But it's being looked at.

SEN. LIEBERMAN: Okay. So now let me go to the vaccine. Am I correct that a decision has been made that if we can develop a vaccine for swine flu we will definitely make it?

DR. SCHUCHAT: I don't believe that decision has been made yet. What's been made is that we are taking all the steps necessary, if we decide to make a vaccine, to make one. So we've got this -- (inaudible) -- strain being looked at both with the traditional egg- based cultures and then also with this reverse-genetics approach. We have industry lined up to be partnering with the government. We have NIH ready to do the clinical trials that would be needed. But there's this phase before you actually go to large-scale production, which will define whether or not you're going to and which kind of vaccine you should make.

SEN. LIEBERMAN: So let me ask this question. If you all with your extraordinary capabilities develop a vaccine that works against swine flu, why would we not make it?

DR. SCHUCHAT: Okay. So first off, CDC doesn't actually make the vaccine. We're just one part of the --

SEN. LIEBERMAN: Understood, but you know what I'm saying. I'm asking a public policy question. I assume if we could develop it we'd make it.

DR. SCHUCHAT: Well, I think we'll be learning quite a bit about what it's going to take to make one in terms of we were disappointed originally with the H5N1 vaccine products. You needed a huge amount of antigen in order to get a response. If you added an adjuvant component you didn't need so much. There's a lot of science that will be going on in the next few weeks or months that will help us understand what we could expect, how much could we make, how much response might it give. Some of the influenza virus strains don't grow that well, and it's hard to make a vaccine from them. So we don't know.

SEN. LIEBERMAN: Secretary, do you want to weigh in on this? Because I would assume that if we can make it, we will.

SEC. NAPOLITANO: Exactly. And again, I want to just say, these decisions need to be informed by science. But vaccines are not in and of themselves benign. So they can themselves cause a certain amount of illness and mortality in the population at large. And so one of the things that you need to look at is, what is the overall benefit of a large-scale vaccine program in terms of the severity of this H1N1 virus versus what you might get from a vaccine? So that just illustrates for you, I think, Mr. Chairman, that there are a lot of factors that need to be taken into account.

SEN. LIEBERMAN: A final question. I assume that if we decided to produce a vaccine because we had found one that worked on swine flu, the aim here would be to produce 300 million doses so that we could at least have the capacity to administer one to every American?

SEC. NAPOLITANO: The planning that was done was with that in mind, including who would be among the first to get such a vaccine, you know, critical infrastructure and some other groups.

SEN. LIEBERMAN: Yeah, talk about hard judgments to make.

SEC. NAPOLITANO: Yes. And we actually did both expert group input and also public engagement about what do people value the most. You know, those who were most like to die from an illness, those who would keep society going? We got very good input from a series of public engagement efforts about that in our planning a couple of years ago.

SEN. LIEBERMAN: Do we have the domestic capacity to produce sufficient quantities of vaccine up to the 300 million?

SEC. NAPOLITANO: The investment in pandemic preparedness that Congress made possible has resulted in phenomenal expansion in manufacturing capacity so that we are very optimistic going forward about what we can expect. But this virus can surprise us. And even with all those investments, it may just technically be difficult.

SEN. LIEBERMAN: Thank you very much.

Senator Collins.

SEN. COLLINS: Thank you, Mr. Chairman.

Doctor, I want to talk further with you about the vaccine issue because the 1976 experience is a real cautionary tale. And I know Secretary Napolitano was saying that she was reading a book about it. And I've refreshed my memory about it as well. In this case, it turns out that health experts were mistaken about the kind of flu. It turned out to be an avian flu, not a swine flu. And the CDC director had urged the president and Congress to undertake a mass inoculation program of the population. And within a few months, almost 25 percent of the population had received the vaccine, but it was not a very happy result. It turned out that the vaccine had serious consequences for some individuals, producing a rare neurological disease. Five hundred people contracted the disease as a side effect of the vaccine, 25 of them died. What have we learned from that terrible experience? It really was a debacle. It cost the head of the CDC at the time his job. What have we learned from that experience in 1976 that we can apply to the situation today?

The reason I ask this is for those who weren't around in 1976 or are too young to remember what happened, there's a tendency to see the vaccine as the magic answer, as the solution. Could you talk to us about what lessons CDC has learned that would prevent a reoccurrence of what happened in 1976?

DR. SCHUCHAT: Thanks for that question. I think that it's humbling going forward to look at the complexity of decision-making that will be necessary. And I think an important lesson to be learned is how important careful deliberation, best-case, worst-case, looking really at all sided of an issue will be needed. The health benefits, the health risks, the social benefits and social risks, the economic issues, I think that we hope to have a -- you know, CDC is just part of the story, of course. But I think we really hope to be able to step back and make decisions carefully amongst the affected groups and to seek wise counsel from dissenting views, to really get people to look at things from a different perspective.

I can mention that CDC pretty much routinely, for our emergency responses and also for this one, has a team b, a group that's really not involved in the response but stepping back and looking at it and trying to think about issues where we really might not be going on the right track or where other perspectives might be very useful. I think Secretary Napolitano might have some other ideas since you refreshed your memory last night.

SEN. COLLINS: Secretary.

SEC. NAPOLITANO: Well, I was a college freshman in 1976, so my memory was a little stretched. (Laughter.)

SEN. COLLINS: It really bugs me when our witnesses are younger than I am, Mr. Chairman. (Laughs.)

SEC. NAPOLITANO: Yeah, I think the doctor has it right. And what we want to do is make sure, moving forward, that we are getting lots of different inputs as we approach what can be some very, very difficult decisions where you're constantly weighing, what's the benefit to be gained versus the cost? And it's not just the CDC but other members of the academic and scientific community, it's members of the private sector who have to give us input about what would be the economic impacts of some of our decisions. And it really has to be taking into account a myriad of different factors in terms of whether you do a universal vaccine program.

SEN. COLLINS: That's the point that I wanted to make is it is not an easy decision to decide to do a mass inoculation. And while I'm sure that the science behind vaccines has improved in the last 30 years, the experience of 1976 should cause us to proceed with caution. And I'm confident that you will do that.

Madame Secretary, I want to turn back to the border issue that we discussed earlier. You took some issue with my description of the process that CBP is using when I described it as passive surveillance. And I think it's important for the record to note that that is the terms that the Department of Homeland Security is using and indeed as recently as two days ago in a press update. The department has said that, The Customs and Border Protection has also implemented passive surveillance protocols. Furthermore in that same document when there's a frequently asked questions part, when the question is asked, what steps are you taking to prevent those with flu-like symptoms from crossing the border, the response is not very reassuring to me and indeed to many other members because the response is, As part of CBP's routine procedures if someone's crossing the border, appears ill, the person is referred to a quarantine station or a local public health official. We should be going beyond routine procedures given the threat.

SEC. NAPOLITANO: Senator, first of all, I think your point is well- taken. We have used the phrase "passive surveillance" but we've also used the phrase swine flu. I mean, as we go through this over these days, we are determining better ways and more precise ways to communicate. So passive seems to suggest that nobody's doing anything. And the answer is they are following a direct protocol to examine, to look, to ask questions. And when they say "routine" what that is is that, for example, we are constantly at the border trying to check to see whether individuals who may have tuberculosis are crossing the border. That's a problem within Mexico. So that if you see somebody present who has signs of illness, coughing and the like, they have a travel history in Mexico, particularly certain states within Mexico, they can be isolated in a room and examined further. That is the routine, but that is virtually identical to how we are dealing with identifying those who may have flu.

SEN. COLLINS: Well, let me tell you why I'm so concerned. In 2007, our committee did an investigation of the case of the Mexican citizen who crossed 21 times back and forth across the border, despite the fact that CDC had identified him as having a highly contagious, drug-resistant strain of tuberculosis. So here's an individual who's been identified by CDC, and yet Customs and Border Protection was still unable to stop him from crossing almost two dozen times.

Now, I have a great deal of respect for how hard the Customs and Border Protection officials are working. I also know that they are very well-meaning and that they are well-trained. But if they can't catch an individual who's been specifically identified as being a public health threat, whose name they actually have, then why should I have any confidence that they're going to be able, using just what are described as passive surveillance protocols, not using electronic scanners or other technology, why should I have confidence that they're going to be able to screen for this serious flu, particularly since, as the chairman mentioned, the volume of people crossing every day is just enormous?

SEC. NAPOLITANO: Senator, I think the question you raise is the same question, in a way, that Senator Graham was raising. Are there some things that we can do with respect to visa issuance and the like that will diminish the possibility of somebody carrying flu coming over? And we are open to those ideas and suggestions. But again, the decision to actually close the entire border, which is what has been raised -- and since we have flu in Canada, I would anticipate that the same argument would be made there -- so closing both borders with all of the huge impacts that that would have, in light of the fact that the scientists and the epidemiologists say would have virtually no impact on the amount of disease in our country. When you balance those things, particularly in light, as you say, of the difficulty of knowing whether any individual has the disease, and we make that whole package of decisions, you understand why closing the border is not an adequate answer to this epidemic.

SEN. COLLINS: Let me -- and I realize my time has long since expired. But let me just make very clear. I am not advocating closing the border. That is not my position. The only time that that would make sense to me, based on the expert testimony we've had today, is if you temporarily close the border in order to allow for the distribution of medicine to key areas or perhaps the vaccination of Customs and Border Protection officials at the border. Then it might make sense to close it for a brief time to allow that to occur. So that's not what I'm advocating.

I am advocating for a stepped-up medical presence at the borders. I am advocating for the use of technology, perhaps these scanners that six other countries are using. Even if they're not perfect, they're going to catch some of the cases. And I am advocating for enhanced, active questioning surveillance techniques. So I just want to clarify that that I think there are steps that can be taken between what we're doing now, which I do not consider to be adequate, versus closing the borders. There are more effective, enhanced methods that could be put in place. And I just urge you to consider them, which you've already indicated you're willing to do.

SEC. NAPOLITANO: Absolutely.

SEN. COLLINS: And again, I do want to applaud you for the response. I've talked to bioterrorism experts who say that we are doing so much better a job. And as the doctor has made clear, our preparedness has grown by leaps and bounds due to the investments that Congress has made and effective leadership. So I thank you for that.

SEC. NAPOLITANO: Thank you, Senator.

SEN. LIEBERMAN: Thanks, Senator Collins.

I echo Senator Collins. I was thinking there at the end, naturally we pushed you, members of the committee, myself included, on some of the tough questions that are, in some sense, ahead. That's the nature of what we're thinking about and what people are asking us. But I don't want that to diminish our feelings, again I speak for myself here, that this was one of those cases where the federal government is prepared, that we have a plan, that we have a department that's relatively new but that coordinates quite a wide array of the agencies that are directly involved here. And in cases where it doesn't have all that direct expertise, it works very closely, obviously, under your incident management position, Secretary Napolitano, with groups like CDC and now Secretary Sebelius at HHS.

So I think there's a lot of reason for the American people to feel encouraged that the federal government is really there on this occasion protecting them. I think you've heard, obviously the president has indicated this by his request for 1.5 billion (dollars) -- Senator Voinovich, ranking member on the Appropriations Homeland Security Committee -- that there's going to be no resistance here to providing you and other departments of our government with all the money you need to protect the American people from the spread of this disease which we're rightly taking seriously.

So I appreciate everything you've done. We're going to, as a committee, stay involved in this. I can't help but express a certain amount of not only gratitude to you, Secretary Napolitano, but pride since this is the committee from which the department originated. And I think you've shown us thus far in this crisis why it was a good idea to form it, not just in response to 9/11 but to help our government better manage a host of other emergencies, including this kind of public health emergency.

So we're going to keep the record of the hearing open. I suppose we should ask each of you, it's a bit unusual, whether you have anything you'd like to say in closing.

DR. SCHUCHAT: Just really appreciate the support that Congress has had for preparedness in the past and to help us with the situation now.

SEN. LIEBERMAN: Thank you.

Secretary.

SEC. NAPOLITANO: Echo that, but also to say that communication here is going to be so important. This is an evolving situation. I was just handed a note that they now have 13 confirmed cases in Canada, which I wasn't able to answer earlier. So, I mean, every half hour, hour, we sort of get a different picture. And my goal is to communicate with the committee, with the Congress what we're doing, why we're making decisions as we make them and to communicate the same with the American people.

SEN. LIEBERMAN: It's very important. We appreciate it a lot. Thank you. The record will stay open for 15 days for additional questions and statements, as desired. For now, that's it for this morning. Thanks for your time. The hearing is adjourned.

END.


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