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CDC Telebriefing Transcript
CDC's Terrorism Preparedness: One Year Later
August 27, 2002
CDC MODERATOR, LISA SWENARSKI: We have brought together the top terrorism
experts at CDC to make some remarks and really devote a lot of time to
Q&A for all of your questions.
I'd also like to point out that CDC is one piece of the Department of
Health and Human Services, which has a very active program in preparing
for a possible terrorism event, and so I urge you all, in addition to
listening to the people here at CDC, to also contact HHS and the other
agencies that are very involved in terrorism preparedness and public
health. And if you don't have the phone number for their Press Office,
Also, if you need to verify anything that was said today, it will be
available by transcript on the website by the end of the day, and also
later this week we will have a press kit with lots of information for you
on terrorism preparedness on the web by the end of the week and some B
roll for TV next week.
In addition, please look out for several MMWRs that will be coming out
next week and the following week with terrorism-related articles.
If I didn't mention it, I'm Lisa Swenarski, the acting director of Media
Relations at CDC. If you have any follow-up questions after this one hour,
please feel free to call our press office at 404-6393.
Today, each of our speakers are going to make some very brief remarks, and
then we will open it up to Q&A. I would first like to present to you
the CDC Director, Dr. Julie Gerberding.
DR. GERBERDING: Thank you very much for being here today. This is really
an opportunity for us to update you on some of the things that we've been
doing over the last year since the terrorist attacks first began, and
we're very happy to have the chance to provide this information in this
It did cause me to look back a little bit on the very first day, 9/11, and
I'm sure we call all remember where we were on that day which is, in a
sense, the world changed for all of us. It certainly changed for CDC.
But there are a couple of other dates that are very important to us as an
agency, also. One is, of course, October 4th, when we confirmed the first
case of inhalation anthrax in the patient in Florida. And then on November
8th, President Bush, Governor Ridge and Secretary Thompson visited CDC,
which I think sent a very strong signal to this agency that we were an
integral part of homeland security, and that message, and that awareness
is certainly shaping our future, shaping our priorities and shaping the
directions that we're taking.
It's not a substitution for our core public health mission, but it
certainly is an addition, and I think I'm pleased to say today that we are
successfully embracing that addition and are very proud of some of the
things that we've been able to accomplish in the last year.
We learned a lot of lessons in the fall. The purpose of this conversation
is not to go into the lessons, but rather to tell you some of the things
that we have accomplished and are going forward with from that point on.
We did step up to the plate in the fall, and since that time, we've really
scaled up our response capacity. We've sped up the processes by which we
do our work, and we've streamlined our overall emergency response
The kinds of programs that you're going to be hearing about today are
really those that address three major components of CDC work. One of the
issues are the actual program components themselves, and I'll mention a
couple of these.
The other is the people and the partnerships that are used to accomplish
And the third is the practice that we do to make sure that our response
capacity is optimized.
In terms of some of the highlights of the programmatic changes that we've
made, the biggest and most conspicuous is, of course, the state and local
grant program for terrorism preparedness and response--the $918 million
that Secretary Thompson made available for state and local health
departments through CDC, which really focuses on the critical components
of preparedness, and already many states have achieved the benchmark
capacities or are well on their way to achieving benchmark capacities in
The criteria for that program were flexibility, speed and accountability,
and we are very much engaged in ensuring that we meet those criteria in
all three categories.
Other programs that I think have expanded or enlarged since 9/11 include
our National Pharmaceutical Stockpile Program. Not only have we added many
medical assets, including new antibiotics and vaccine products to the
stockpile, but also we've increased the absolute number of the push packs.
These are the large containers full of medical resources that are deployed
at strategic locations around the United States.
We've also increased the number of personnel involved in this program and
remain fully confident that should there be another terrorist event or any
other mass casualty event, we could get the stockpile to the site of need
within 12 hours in the United States.
Another major component has been our laboratory capacity program, both
here at CDC, as well as the laboratory response network, which now has
more than 200 laboratories that are actively engaged in the detection,
diagnosis and evaluation of samples that could represent a pathogen of
bioterrorist origin. I think Dr. Hughes will say a couple more words about
the laboratory response network.
But at CDC, laboratory response capacity has been a high priority, both
for biologic agents, as well as chemical toxins, and we have expanded our
capacity, expanded our throughput, and we've even opened new laboratory
facilities since 9/11 to ensure that we have the full surge capacity that
we need to deal with these problems.
We're not finished. We've got more expansion and more work to do in the
laboratory compartment, but we've certainly taken some giant steps
forward, and we're very pleased with those accomplishments.
Now talking a little bit about some of the things that people have done.
We have rapid response teams here at CDC, and these are individuals who
are ready to basically load and go whenever a problem arises. So they have
special training. It's a mixture of people with a variety of skills,
including communication skills, laboratory skills, epidemiology, whatever
it takes to get to a site of a terrorist attack and start the ground
investigation and ground response in quick order.
Our EIS officers have had special training this year in the field,
practicing coordination of a bioterrorism event at one of our partner
organizations in another state. So the EIS officers are now getting
training in emergency response and will be a much more ready part of our
I think the other major investment in people is the expansion of our
communications capacity here at CDC. We've hired and recruited a number of
new health communications experts, and we've developed an emergency
communications plan which is I think an enormous change in the way we do
business here, and I hope that you will identify differences as you
interact with us and see the fruits of that effort that Dr. Freimuth [ph]
and her colleagues have been leading in the communications arena.
Finally, let me talk a little bit about practice because I think
practicing or exercising our response capacity is certainly valuable. We
exercised our response capacity in the fall, and we've done a number of
lookbacks at that to identify where we needed to improve. But since that
time, we've also had opportunities for scenario development, for expert
consultations from people from the outside. We're planning a large
tabletop and have participated in some small tabletop exercises. But most
recently you probably recognize that we're very involved in the West Nile
outbreaks in multiple jurisdictions around the United States, and this
West Nile infection outbreak experience has given us an opportunity to
practice our public health response capacity. And we are, in fact,
managing the West Nile outbreaks using our Operations Center. We are using
our communications strategy for that outbreak, and we are deploying and
managing the people in the field using the same style of leadership and
the same operations concepts that we would do if we were actually dealing
with a terrorist attack.
Now, in no way am I implying that West Nile has anything to do with
terrorism. It is a totally natural epidemic. But I think it sends the
message or illustrates the concept that the kinds of investments that we
make in public health to handle natural public health problems are exactly
the same infrastructure and the same mechanisms that we use for dealing
with a terrorism attack. So this concept of dual functionality is not only
a good way for us to exercise, but it really is how we've evolved our
We are building terrorism capacity on the foundation of public health, but
we are also using the new investments in terrorism to strengthen the
public health foundation. And these two programs are inextricably linked,
and I think both will benefit from the efforts and the investments that we
intend to make on an ongoing basis.
So let me just end by saying it one more time. We are scaling up, speeding
up, and streamlining our operations. Our preparedness is very high, but
we're not satisfied, and we have more work to do, and we intend to get the
job done right.
MS. SWENARSKI: Our next speaker is Joseph Henderson, Associate Director
for Bioterrorism Preparedness and Response at CDC.
MR. HENDERSON: Thank you, Lisa. Thank you, Dr. Gerberding, for those
comments and providing the broad base of the activities that we're all
engaged in here at CDC.
The state and local program, which I'll talk about briefly, has gone
through substantial change in the past year. CDC has been working on
developing capacity at the state and local level since 1999. On average,
we had about $120 to $180 million a year to support state and local
activities to include laboratory capacity, the capacity to enhance
surveillance, disease detection, to enhance the ability to do case
investigations so we can control and contain the consequences of an
outbreak, whether it's biological or chemical or dealing with issues of
Now, in the past year, of course, that's changed considerably. We have
almost a tenfold increase in funds. Our extramural program, which was last
year about $50 million, has gone up to about $918 million, with a lot of
the responsibility falling on the shoulders of our state and local
colleagues, which altogether make up our entire public health system.
I think we've made pretty remarkable advances at the state and local
level. States like Florida have done some very significant work in
understanding how to receive one of the push-packs that Dr. Gerberding
talked about, and the push-packs themselves, which I know Dr. Jackson will
probably mention, are not just a few boxes that come in through Federal
Express. They're about 100 huge cargo containers and the logistics behind
just getting them from Point A to Point B are difficult enough Compound
that with the need to get them to distribution points in a state or local
jurisdiction are very complicated. Florida has done pretty substantial
work in that respect, but a lot of states obviously need to do more to
understand the logistics associated with getting medicines from a
warehouse into people's arms or into their bodies.
So we continue to work with our state and local colleagues to build an
entire infrastructure that can improve its response capacities. People
always ask me if we were to respond tomorrow, would we do a better job
than we did a year ago, and there's no question we clearly could, both as
an agency, but also with the state and local health departments having
these resources, and clearly in a better position to respond than we were
a year ago.
So we're making significant advancements working with them to include
laboratory capacity, which I know Dr. Hughes will touch on. The one point
I wanted to make that's important is one of the critical components of
response that we're seeing evolve rapidly is the need to develop the
linkages and partnerships with the existing emergency management system
that's been in place in this country for many, many years. If anything,
the planning which is bringing all these various groups to the table is
clearly building those linkages and relationships. And I think we're
making some success. We have some work to do, but clearly we're in a
better situation today than we were a year ago.
MS. SWENARSKI : Our next speaker is Dr. James Hughes, Director of National
Center for Infectious Diseases.
DR. HUGHES: Thank you very much, Lisa. Good afternoon.
As you've heard, we have a new way of doing business at CDC dating back to
last September. We and the Department of Health and Human Services remain
on extremely high alert because of the threat of another act of
bioterrorism as well as the threat of infectious disease outbreaks
generally. We've taken steps to improve our public health surveillance
capacity to monitor for the occurrence and early detection of infectious
disease outbreaks anywhere in the country and, indeed, are working with
partners in other parts of the world to strengthen surveillance capacity
there as well.
Some examples of some of the kinds of things that are actively being done
to strengthen surveillance capacity at the local level are monitoring of
emergency room visits, monitoring of pharmacy records so that use of anti-diarrheals
or antibiotics can be monitored, monitoring 911 calls, monitoring calls to
Poison Control Centers, strengthening linkages to the veterinary community
because of the fact that some of these diseases affect animals as well as
As you've heard, we've also strengthened our laboratory capacity. We've
made large investments in the Laboratory Response Network, or LRN, which
is a national network of public health laboratories in collaboration with
the Association of Public Health Laboratories, and there's at least one of
these laboratories now in each of the 50 states.
This network played an integral part in the response to the anthrax
attacks last fall. Members of this system tested over 125,000 clinical
specimens during the response to that attack and over a million
As you've heard, we now have an Emergency Operations Center. We're using
that right now to help manage the response to the West Nile outbreak,
which is, as you know, a national problem. But this has greatly increased
our ability to work in a timely with partners around the country.
Finally, we've put a great priority on educating health care workers,
particularly doctors and nurses, but other health care providers as well.
These individuals need to learn considerably more about the clinical
aspects of diseases that may result from bioterrorism, start with anthrax
and smallpox, but clearly there's a broad range of other threat agents
that health care providers need to be educated about.
We've to date educated thousands of health care providers around the
country, but we have much more to do, and so let me conclude by
reinforcing the comments of others. I hope you can tell we are no
complacent about these threats that we face.
MS. SWENARSKI : And our next speaker, Dr. Richard Jackson, Director of
CDC's National Center for Environmental Health.
DR. JACKSON: Good afternoon. Thank you, Lisa.
On September 10th, or before September 11th, CDC had an ability and were
mandated by Congress to look at radiation risks around nuclear events,
weapons sites, and the rest. We had a mandate and a responsibility to look
at chemical residues in people. What are the risks from various chemicals
in the environment? You probably heard about the Fallon investigation and
the matter that we've been working on.
We had a mandate to set up a stockpile and to have antidotes and
antibiotics in the stockpile and ready to be distributed throughout the
country on short notice. And we had a mandate and responsibility for
emergency response for CDC. We were the intake function for calls about
That's all there, but a whole lot more since September 11th. First of all,
fixing up the ability to intake information, alarms, and calls, we now
have two people on duty around the clock. We are--we have a temporary but
high-quality Emergency Response Center in place Operations Center, and
with Dr. Gerberding's leadership and Tommy Thompson's leadership, by the
end of the year there will be a state-of-the-art Emergency Operations
Center. We've brought consultants in from both--we've dealt with both the
Pentagon and FEMA to help us design that Operations Center so that it
would really be top-flight and be able to turn information around.
Our chemistry laboratory, which is focused on chemicals in people and does
specific studies, has been tooled up, and we can now look at 150 toxic
chemicals in human beings that could be used as chemical weapons. And so
we get a specimen from a human. We don't look at environmental specimens.
We get human specimens, blood or urine, from a site, we can tell you what
were the chemicals being used within about 24 hours, and we can ramp up.
All of our people in our laboratory have been trained to put down what
they are doing and transfer immediately to handling terrorism-related
specimens in a chemical event. And by the end of about three days, if we
know which chemicals we'll be looking at, we can handle thousands of
specimens a day.
So we've really changed the laboratory in its focus and its activity, and
we're working very closely with FBI, EPA, CIA, and the other federal
leadership agencies on this. You can't do this kind of stuff in isolation.
And, last of all, in the radiation arena, it was important to do a
retrospective look at threats, but we have asked our nuclear physicists
and others to think about prospective threats. What are the worst things
that you can imagine? How would you prepare for these? And we brought in,
in the middle of June, about 50 experts, hospital leaders, emergency room
docs, radiation specialists, and the rest, who have given us guidance
about how you would set up hospitals, how you would prepare them, how you
triage people, how you set up centers outside the hospital to deal with
persons injured in a radiological or nuclear event.
So the bottom line that I want to convey here is, yes, bioterrorism is
important and bio--CDC is working hard to prepare for it, but CDC also
must respond to all threats, and that includes chemical and radiation as
MS. SWENARSKI: Dr. Kathleen Rest, Deputy Director of NIOSH, the CDC's
National Institute for Occupational Safety & Health.
DR. REST: Thank you, Lisa, and good afternoon, everyone.
The World Trade Center and the anthrax attacks highlighted more than ever
before in recent history the importance of worker safety and health in
this country. The employees in the World Trade Center Towers, the
emergency responders at Ground Zero, the employees in the media and
government offices that were targeted for the anthrax attacks, as well as
the postal workers who worked all along the route of those letters faced a
severe risk of injury, illness, and death because they were at work and on
When a disaster occurs, we rely in this country on our emergency
responders to put themselves in harm's way and to come in and to protect
the public that is involved in the incident at hand. It's up to us to make
sure that the emergency responders have the tools that they need in order
to protect themselves so that they can go in and do their vitally
Now, as you all know, the National Institute for Occupational Safety &
Health is the agency within HHS and CDC that does work on research and
prevention of work-related injury and illness, and I wanted to give you
just a couple of examples of some of the work that we've been doing
post-9/11 and post-anthrax.
During those times, of course, we were with our CDC colleagues and
responded, providing technical assistance on-site in New York and in the
various postal facilities. But what I wanted to do today is tell you a
little bit about what we've done since these times back in the fall.
Since September 11th, we've worked very actively with the emergency
response community, with workers and employers, and our partners to do a
number of things.
One is that we convened a national workshop of firefighters and other
first responders, government agencies, manufacturers and stakeholders to
identify needs relating to personal protective equipment like respirators
and other protective ensembles that our emergency responders need to
protect themselves when they go into these situations. We've issued a
report, it's in writing, it's on the Web, and we're happy to make that
report available to you of this workshop.
We've also issued new certification standards for classes of respirators
so that emergency responders can know that when they go into a terrorist
incident, they will be protected from chemical, biological, nuclear and
radiological agents. NIOSH has certified respirators for industrial use.
So, drawing on the experience that we've had, we are now actively pursuing
certification programs for respirators and personal protective equipment
to protect against these new agents.
As you may know, we're supporting a consortium of occupational health
clinics in New York to provide some baseline medical screening for the
workers, emergency responders, rescue and recovery workers that were
involved in the 9/11 effort that will be able to help us determine whether
they are suffering any adverse consequences because of their work.
We're conducting a variety of field studies also in New York of people
that worked around the World Trade Center site in office buildings,
transit workers, school employees proximate to the site, who were exposed
to airborne dust to find out if they're suffering any ill event.
And, also, I guess, finally, we all realized after 9/11 and the anthrax
attacks, that we are vulnerable to potential attacks to commercial
buildings, government buildings and others to radiological, chemical,
biological agents. So we have been working with partners and experts in
other federal agencies to try to develop some practical guidelines that
building owners can use to help harden their buildings and protect
themselves from the vulnerability that they may have with their air intake
systems. Again, there's a report available that we'd be happy to make sure
that you have.
So, in closing, I think that we at CDC, and in HHS and in NIOSH really
recognize the unique contributions that we need to make in terms of worker
protection relating to terrorism. Because one thing we do know, that any
and every future disaster, whether we're talking a terrorist disaster or a
natural disaster, will involve workers in some way, and we have to be
actively continuing our work to be able to make sure that these workers
have the information and the tools that they need to respond in the way
that we need to them to.
CDC MODERATOR: Thank you, everyone.
We'll open it up to questions and answers now. We will alternative between
questions from the room and questions from the telephone. Please state who
you're directing your question to, and those of you on the telephone, if
you have a hard time hearing the questions from the audience here, please
let us know, and we'll repeat the question.
QUESTION: Hi. [Inaudible] from CNN. I've got a question about smallpox
vaccine. CDC recently had issued a recommendation. My question is what is
the recommendation of CDC now; who should be vaccinated, how many first
responders, 15,000 or 500,000, and when we will we hear when the decision
will be made, and then how will the vaccinations occur, [inaudible] or
DR. GERBERDING: Let me, first of all, make a point of clarification. CDC
has not issued new guidelines on smallpox vaccine. An Advisory Committee
to CDC made some recommendations, and that's a very important distinction
QUESTION: Well, CDC recommendation. I didn't say--I didn't say that you
had issued guidelines.
DR. GERBERDING: Yes. CDC has not made recommendations on smallpox vaccine.
An external body of people have done that, and we have responded to the
recommendations from that Advisory Committee. We're working with Secretary
Thompson and the experts in the Department of Health and Human Services to
make a final determination of the federal policy in the context of
homeland security and national security.
So we've gone forward with the public health perspective, but that's being
weighed in the light of the other events that are unfolding. We don't have
a final plan yet, but I can assure you that we are working almost around
the clock to get the plans finalized and to make sure that we understand
the logistical implications and the resource implications, as well as the
human implications of any decisions that are made.
QUESTION: If I may follow up. [Inaudible.] If I were asking you, for the
people out there, the normal people, not in the media, [inaudible], why
can't I get it? So, from the CDC perspective, what do you think should
DR. GERBERDING: One of the things that it's important to appreciate is
that the vaccine products that we have available right now today, we have
a vaccine that we can use in an emergency, but it's an investigational
vaccine, and it requires informed consent, and it's best to think of it
more or less as a research protocol, and so we don't generally make things
available to people on a research protocol unless there's a strong reason
As we move into an era when the vaccine is licensed and we know more about
the new products that we're purchasing from the manufacturer, I think we
can revisit this issue of whether it's appropriate for people to have
voluntary access to the vaccine, but it's premature at this point.
CDC MODERATOR: It appears our friends on the telephone cannot hear the
questions from the audience, so in the future I will be repeating your
We'll take the first question from the telephone, please.
AT&T OPERATOR: Thank you. That will come from the line of Deidre
Henderson with the Denver Post. Go ahead.
QUESTION: This question is for Dr. Gerberding.
In light of the CDC's current handling of the West Nile outbreak as a
proxy for how the Agency would handle future bioterrorism attacks, I have
a question about the timeliness of CDC turnaround of human specimens.
The Agency has said that given its experience with past West Nile
outbreaks, it is expected to see a ramp-up in suspected human cases in
August, but despite that, there's been an increasing lag time between the
time the CDC receives the human samples and the actual confirmation.
Are there any strategies for a quicker turnaround on those confirmation
DR. GERBERDING: Actually, we've been doing--thank you for bringing that
up. We've been doing an evaluation of the time from a patient presenting
with the symptoms or signs of West Nile infection and the time that the
laboratory at CDC is able to document that that's the source of the
infection. And there are many components to that period of time. One of
the biggest is the time it takes for the clinicians taking care of the
patients to order the test and get it to the state laboratory. Then there
are turnaround times in the state laboratory that add several days to the
equation, especially if the sample is not obviously positive. And
sometimes early infection, it's an equivocal test result, so it has to be
CDC does not confirm all of the West Nile tests that are done at the state
labs because over the last couple of years we've learned that the state
labs are quite proficient. So when there's a new case in a new
jurisdiction, often they'll send the specimen to us to do the special
confirmatory test, and we're happy to do that and actually appreciate the
opportunity because it helps us. But we are not in the business of
confirming every West Nile test once the state has documented that the
infection is there and they know they're having an outbreak because
they're very competent and proficient at doing them themselves.
Where we come into play is when the test is confusing, and sometimes this
happens in a state where the test result is ambiguous and there's a
special test that we have to do called the plaque neutralization assay,
and it takes a week to ten days to get the results from that test because
it involves growing virus in a petri dish. It's not a rapid test.
So that's part of the reason why you see a delay in the CDC lab, because
we're being called in when it's complicated and we have to use the special
MS. SWENARSKI : Next question from the audience.
QUESTION: Can I continue with the West Nile? Here in Georgia we have six
cases that were confirmed by the state but never confirmed by the CDC.
Have you confirmed those or will you be confirming those?
DR. GERBERDING : Again, the verification of the West Nile case is left to
the jurisdiction of the state. So when we report verified cases, these are
cases that the state has reported to us as having been tested and verified
and have entered into the surveillance system.
Sometimes we hear rumors about other cases, and clinicians are confused
about CDC's role in doing the actual confirmatory testing. But the bottom
line is it's really the state call.
In Georgia, we were asked to look at some samples and to confirm them, and
the evaluation of both samples is ongoing as we speak.
MS. SWENARSKI : We'd be happy to set you up with our West Nile experts if
there are any questions on West Nile afterward. We'd like to devote this
precious hour to terrorism-related questions.
So the next question from the telephone, please?
AT&T OPERATOR: That will come from C.C. Connelly with the Washington
Post. Go ahead, please.
QUESTION: Yes, thank you. Dr. Gerberding, I wanted to follow up a little
bit on the questioning regarding the smallpox vaccine. First, I'm
wondering if CDC has been able to assess and weigh in on liability
questions around administering that vaccine. You mentioned an IND. Do you
need to file any additional IND if the policy is for a broader vaccination
DR. GERBERDING: The IND, investigational new drug, status of the vaccine
products that we can currently use would not need to be modified based on
expansion of who we would be offering pre-immunization or
post-immunization vaccine to. Our protocols and our application status has
accommodated for that--accommodated that.
And the liability issue is one that the department and CDC, FDA, and
others are actively pursuing.
QUESTION: The reason I ask that is my understanding that when you had the
fairly large-scale swine flu vaccine, liability ended up being fairly
costly. I'm wondering if you can give us some insight on whether or not
there are lessons to be drawn from that experience. And just to be clear,
when you said the IND status would not need to be modified, is that true
even if you're talking about a half a million people?
DR. GERBERDING: The IND is not based on the number of people who are
vaccinated. It's based on the protocol used to do the immunization. So
that is--that is a correct statement.
In terms of the importance of liability, anytime you go forward with a
vaccine or any other product that has investigational status, liability is
a very, very important question. It was an important question for swine
flu. It was an important question for anthrax vaccine. And it's an
important question for smallpox vaccine. And it's one that we are not
MS. SWENARSKI : Next question from the audience, [inaudible].
QUESTION: A question for anyone on the panel. Mike Tobin with the Atlanta
Constitution. You've outlined quite a number of changes you've made in the
last year in response to the anthrax attacks. I wonder if you would
attempt to balance the changes that you've made against the knowledge that
you've gained from what was an extremely limited and apparently not
particularly well coordinated effort at biological warfare. Do you
personally feel more or less secure today than you did a year ago?
MS. SWENARSKI: The question is we've gone over some changes that we've
made in the last year, and Mike Tobin, Atlanta Journal Constitution, would
like to know if we could balance the changes we've made with the knowledge
we've gained in bio-warfare and do we feel more comfortable now than we
did a year ago.
DR. HUGHES: This is Jim Hughes. Let me make some initial comments.
The anthrax attacks through the U.S. postal system last fall was
unprecedented. It was tragic. It had an enormous impact on the country.
Nevertheless, as the questioner noted, it was a small attack, and it's
important to note that it could have been much worse. It could have been
much more complicated in many ways. It's one of the reasons why we are not
complacent at all.
We certainly learned many lessons from the response to that attack, and a
number of them have been enunciated already in this session. We are
putting them to use in the response to the West Nile epidemic showing the
dual utility of these investments.
One of the areas where we've definitely made improvements is in
cooperation with partners, and hopefully in communication. So I would say
that we're substantially better off today in responding to this year's
West Nile national extension in a much more effective way now than we
would have been absent the experience in responding to the attacks.
MS. SWENARSKI: Next question from the telephone, please.
AT&T OPERATOR: Thank you. That'll be from Adam Marcus with Health
Scout. Go ahead.
QUESTION: I imagine this is for Dr. Gerberding. I'm curious what
percentage of the CDC budget is now devoted to terrorism preparedness, and
have there been other areas of the CDC's more conventional mandate that
have seen a percentage drop in their budget? And do you think that that's
led them to suffer in any way?
DR. GERBERDING: You know, you're asking me a question that, on the one
hand, would be straightforward by just looking at how the pie is divided
up and how it comes in to CDC. But, in fact, the point I made earlier
about building terrorism programs on the foundation of public health is a
complication that makes the answer to your question not so
In other words, we have existing systems for conducting surveillance of
emerging infectious diseases in a number of jurisdictions, including the
state health departments. That is a very important foundation for
terrorism preparedness and response, but it's not paid for out of dollars
that are earmarked as bioterrorism dollars. So we have dual-purpose
programs, but we also leverage our investments to get dual functionality
out of them.
So I can't really answer your question. It is important to note that the
state and local grant program for terrorism preparedness and response is
$918 million. We have an additional increment of resources for intramural
programs, some of which also goes out for research and for other programs.
Dick can speak to the investments in the stockpile and the medical assets
that are kept there. But we are not taking away from other programs to
enhance terrorism, but we are trying to make these investments have as
much impact overall as we can.
QUESTION: Am I still on?
MS. SWENARSKI: Do you have a follow-up?
QUESTION: I do. One way, instead of looking at dollars, might be to look
at person-hours. Do you have the same level of staffing that you did a
year ago? And if so, how are they allocated? And are more people working
on terrorism and less on other things?
DR. GERBERDING: The answer to your question is we have more personnel. One
of the most important new additions to our staff is sitting next to me,
Dr. Joe--Mister--excuse me. I've done that twice now--Mr. Joe Henderson,
who's Associate Director for Terrorism Preparedness and Response, who's
really coordinating all of our activities. And we are hiring a number of
people to support the extramural grant program as well as the expanded
capacities internally. But, again, the existing personnel are also
contributing to our terrorism response capacity, and the biggest evidence
of that occurred in the fall, and we basically called upon skilled people
from across CDC from all centers and components of our organization to
contribute. So this is part of our core business, and we use part of our
core staff to accomplish these tasks.
MS. SWENARSKI: Next question from the audience?
QUESTION: Yes, Rick Blaylock (ph) from Channel 11 [inaudible]. Recently, a
couple days ago, I guess, Vice President Cheney talked about [inaudible]
Iraq, the President's talked about it. Some people are questioning whether
that's a good idea because of the fact that if we go to war with Iraq, the
possibility of further warfare here in this country or [inaudible] anthrax
or other type of biological war would happen.
Is CDC prepared or are we ready to handle the consequences [inaudible] if
we ended up in a situation like this? And, secondly, my question would be:
How much consultation has CDC provided the White House [inaudible]?
MS. SWENARSKI: Just to preface it, obviously we have a big enough mission
without having to get into foreign policy at CDC. But certainly Dr.
Gerberding could talk about where our preparedness level is. The question,
for those of you on the telephone, from Channel 11 is that there has been
in the news some discussion about possible war with Iraq, and is CDC ready
for a bioterrorism event that might be related to that? And how much has
CDC advised the White House in relation to that?
DR. GERBERDING: CDC's mission is to protect public health, and so we look
at both domestic and international events from the standpoint of what is
necessary to protect the health of the public. And so that is our role,
and that would be our role with any kind of major event, a natural
epidemic, a terrorist attack, or even a war. And so from that standpoint,
we are, of course, very invested and concerned about thinking through the
potential consequences to public health.
Fortunately, war per se is less likely to be a public health issue than
some of the other terrorist kinds of activities that we've been talking
QUESTION: [inaudible] ancillary things that could happen as a result of
[inaudible] war in terms of [inaudible] you know, and the things
[inaudible] so forth. [inaudible] should something like that occur as a
result of the United States maybe being involved in--do you understand
what I'm saying? If we attack Iraq [inaudible] public health issue. Have
we [inaudible] any issue consulted the White House [inaudible]?
DR. GERBERDING: There's a subtle distinction between bioterrorism and
bio-warfare. We are addressing both of them in our state of preparedness.
MS. SWENARSKI: Next question from the telephone.
AT&T OPERATOR: We will go to the line of Bill Welsh with Washington
Technology. Go ahead.
QUESTION: Hi, Bill Welsh with Washington Technology. My question is about
state health alert networks, and it's for the gentleman that was
discussing state and local coordination whose name I didn't catch. And the
question is this: Are any of the state health alert networks up and
running right now? We've been told that Texas was the first to go live
when it launched August 9. Is that accurate?
MR. HENDERSON: Yeah, this is Joe Henderson. I think we can say beyond a
shadow of a doubt that the health alert network across the country is
far-reaching. I can't think of too many local health jurisdictions which
number in the thousands that don't have some connectivity to the health
alert network. I know all the states have connectivity. It's a pretty
robust network, and it exists across the spectrum of our public health
system right now.
As far as Texas being the first up, you know, I have not heard that
before. I was always under the impression that many states came live or
were able to receive health alerts almost simultaneously. So that's new
information to me.
DR. GERBERDING: I'll just add that on 9/11 we sent a health alert, and it
went to every state in the country. What you may be talking about is the
level of penetration into the clinical community. So we can get to health
departments that we want to be able to put that information throughout the
entire response system, including the clinicians on the front line who
need to have that information to respond to patient issues, and there are
still some gaps in the alert system to get to those people
instantaneously. That's why we're developing other mechanisms involving
other partners, including medical associations, to make sure that we get
down the last common denominator of the response team.
MS. SWENARSKI: Next question from the audience, please.
QUESTION: I have a question [inaudible]. If something happened [inaudible]
how would the CDC respond? What would be different? I remember when in the
fall [inaudible] very quickly [inaudible] press conferences were held at
the postal facility where later on it was found to be contaminated, and it
might not have been [inaudible]. So given [inaudible] if something
happened today, what would [inaudible]?
MS. SWENARSKI : Let me repeat that question for those on the telephone.
CNN is asking if we had another situation like last fall related to
anthrax happen today, what would differ in CDC's response?
DR. GERBERDING : Let me just start, and then I would like to Dr. Hughes to
chime in here.
I think one of the most important things that would be different this time
around is that we would prepare people for the fact that we learn as we
go, and what's going on today is not likely to be the same as what's going
on tomorrow because we will have new information and we will be learning
something. So in a sense, our capacity to communicate up front, this is
what we know today, this is what we don't know, this is what we're going
to do to find out, and tomorrow we will update you again. I think that
will be a very major difference.
Jim, maybe you had some other perspective.
DR. HUGHES: Yes, this is Jim Hughes. Let me just add a little bit to that.
We would also be very alert in our response to another attack should it
occur. Obviously, we've experienced one attack. Terrorists know how we
responded to that, and they might take that into consideration in whatever
their modus operandi turns out to be. So although we would be much better
prepared to know how to use nasal swabs, for example, than we were a year
ago, we would not want to get into a cookbook response to this outbreak
because of the possibility that the nature of the organism might be
different, that there might be antibiotic resistance that would be more of
So we would be alert and more efficient in our response. We would want to
characterize very, very rapidly the organism that is responsible, and all
this hinges on active surveillance systems and alert clinicians who are in
frequent communication with local and state health department authorities
because this attack in the fall was recognized at a very local level, and
we suspect that that will be the case in the future as well.
DR. GERBERDING : Dick, do you want to add something?
DR. JACKSON: I think one--this is Richard Jackson. One other significant
change is the upgrading of the Emergency Operations Center. Prior to 9/11,
we had a rather small ad hoc activity, and in order to manage thousands of
specimens, dozens, hundreds of people in the field, requires an
operational center that's physically set up to manage that kind of
thing--large screens, satellite connections, secure communications and the
With the help of the CDC Foundation, the Marcus Foundation and others, as
well as help from the department, that is in place temporarily, but by the
end of this calendar year, we will physically have an operations center
that is the quality of anything in the world.
DR. GERBERDING And Joe I think has an important point to add also.
MR. HENDERSON: This is Joe Henderson. Just one final point. I think it's
an important lesson that we learned last year and we continue to learn in
the anthrax investigation, is the coupling of the epidemiological
investigation, the investigation of the disease outbreak and the response,
with the criminal investigation that's being conducted by the FBI and
local law enforcement.
In the fall, in some cases that worked very, very well, and in other cases
we could improve that relationship. And I think it's going to be an
ongoing issue for us, especially if we have a communicable disease, which
anthrax is not. And we've learned a lot, and we continue to learn. Working
with them is just an ongoing process.
DR. GERBERDING: I have to just add one more thing because it's an exciting
thing for me. When you're involved in an outbreak or the intense
investigation that we were involved in in the fall, it's really hard to
step back away from it and retain your scientific perspective and your big
One of the lessons we learned is that we need to set aside some scientists
at CDC and outside of CDC who aren't involved in the day-to-day things but
are there to second-guess or ask questions or go to the library or, you
know, get answers to things that come up on a moment's notice. And during
this West Nile exercise right now, we have a team of people, sort of the
Team B, who are not involved in managing the West Nile operation but who
are looking at the research questions, identifying the information needs,
going to external experts for input and advice, and really keeping that
balanced perspective. I think that's also a very, very helpful component
of an effective response system.
MS. SWENARSKI : Next question from the telephone.
AT&T OPERATOR: That would be from Laurie Garrett (ph) with Newsday.
Please go ahead.
QUESTION: Thank you very much. First, if I may make a quick comment
regarding improving communications, which I think all of us in the media
would greatly applaud, I only received notification of this about five
minutes before the press conference started, and I don't--and I got it
third-hand. I don't know how notification has been done, but it would be
really, really great if we could set up some more formal system of
establishing sort of getting to know you between those of us in the media
that are on this feed on a routine permanent basis and the new press team
there at CDC. That's just a suggestion.
Meanwhile, two quick questions. One, all of you have mentioned the FY--I
believe 2002 figure of $918 million for local and state preparedness.
Where do we stand with the FY 2003 figure, or is that 918 the FY 2003? I
just want clarification on--FY 2003's approaching.
And then the second real quick question for Julie. I understand that--or
Dr. Gerberding. I understand that the CDC will shortly be announcing a
gigantic epidemiological prospective study that will involve 200,000 New
Yorkers potentially exposed to Ground Zero air and take place for a
20-year period. I also understand that so far in terms of all the meetings
set up to determine who will be in that 200,000 people surveyed, it
specifically only includes residents of Manhattan, though the plume from
it went directly on 9/11, according to NASA space shots, to Brooklyn and
the primary residential exposure was Brooklyn, not Manhattan.
I wonder if you have any plans to include anybody other than workers who
happen to live in Brooklyn but worked at Ground Zero, any residential
environmental exposure cases from the borough of Brooklyn, or will it
remain as currently designed, exclusively for residents of the borough of
DR. GERBERDING: With respect to the first question about funding, the
dollar figure that you're citing, the 918, is the amount of money that HHS
made available to state and local health departments for FY02 supplemental
funding. So it represents money that was added into the budget basically
for supplementing some of the things that already existed. And we're very
optimistic that the budget in 2003 will be at the same level or better,
although we are not able to disclose those figures at the moment because
the budget is not yet approved.
With respect to the other question, I believe what you're talking about is
the registry project which is going on with ATSDR and the investigators in
New York, and I do not know the details of the eligibility criteria, so
I'm looking at the panel to see if others might know what the criteria are
for inclusion. We can follow up on that and get back to you.
MS. SWENARSKI : Laurie [inaudible] I'll have someone [inaudible] call you,
and also we sent the media advisory out yesterday at noon to our regular
beat reporters [inaudible] sure we have it.
Did anybody else have a problem getting the advisory in time?
QUESTION: I guess I'm not on your list of regular beat reporters --
MS. SWENARSKI: Next question from the audience.
QUESTION: I have a question, I guess, for Dr. Hughes or anybody else on
the panel, and it's about health care workers. Are health care workers
really ready if something were to happen [inaudible] emergency room
workers? And if [inaudible] monitoring and making sure, and doctors are
very busy, how are they fitting this into their schedule?
MS. SWENARSKI : Okay. The question is: Are health care workers ready for
[inaudible] incident? And what is CDC doing in terms of training in that
DR. HUGHES: This is Jim Hughes. As I mentioned in the opening remarks,
clinician education is a very high priority for us. Remember that the
visas that are those of greatest concern from the standpoint of terrorism,
which are anthrax, smallpox, plague, tularemia, botulism, and viral
hemorrhagic fevers are diseases that either don't occur at all in the U.S.
or in the world, in the case of smallpox, or occur, but at a very low
So they are diseases that clinicians, physicians, nurses, other health
care providers are not familiar with. They may have heard a little bit
about them back in medical school, but they certainly, by and large,
haven't had to deal with them since.
So we're starting at a fairly basic level, and there are a number of
approaches that we've used. We've used some satellite video conferences
through the Public Health Training Network here at CDC that has reached a
large number of clinicians during the response to anthrax. Subsequently,
there have been courses on smallpox, and we had one recently to provide
clinicians and other health care providers with information on clinical
manifestations of West Nile encephalitis, again, a disease that's not
familiar to clinicians in this country.
We've used our website. We've used publications. We've worked with
professional societies and other groups who are also very interested in
reaching out to the clinical community. We had a meeting here back in
January, where we brought members of professional societies together.
We're working with them to try to standardize some of the information.
This is an area that's been of great interest to Dr. Gerberding, too, and
she may want to elaborate.
DR. GERBERDING: Yes. We really do look at the information needs from the
standpoint of the just-in-case information, and that is what do people
need to know just in case they see a patient who looks like they might
have a toxic exposure or an infectious exposure, and then the just-in-time
information, which is what do people need when something is happening, and
they are likely to be managing or need to be updated on a day-to-day basis
about the evolving guidelines.
The just-in-case information system, we just had two more consultations
with experts who participated in that over the last week, and it's moving
along in a rapid pace. It includes, for the Level A providers, which is
basically anybody at the front edge: What does the common syndrome look
like, the important syndromes; what do you need to do in terms of ordering
tests; what isolation is necessary if it's an infectious agent or a toxin
that could contaminate others; and how do you report it?
And it's that linkage between the suspicion, the lab, and the reporting
mechanism that we're really trying to emphasize the most, but we also want
people to get help. So, if they're suspicious, they're going to call and
consult, and that brings us to Level B, which is how do we educate the
infectious disease export or the neurologist or the dermatologist so that
they have the expanded knowledge they need to provide appropriate clinical
And then Level C is really the teachers. Who are the peer experts that
will be going out and doing the continuing education for the clinician
community? Most of those people are in the professional organizations that
have been coming in and really serve as credible and respected experts
from the medical community who can provide that layer of education.
So I think we're well on our way. And one of the great examples of this,
and I know Jim has been experiencing over the last several months, is we
get calls periodically from people, for example, with a fever and a rash,
and there's concern that it's smallpox.
And so the clinicians in that locale are vigilant. They're looking for
these problems, and when they're concerned, they're calling their health
department, they're calling CDC. We're evaluating, sometimes through
telemedicine, sometimes we go on-site and get samples and so forth,
depending on the level of suspicion.
But we're practicing and exercising our capacity, but it's also telling us
that the message is hitting home because the clinicians are calling us
when they're concerned. So I think we're making good progress here, and we
love those false alarms because it tells people are alert and they are
QUESTION: Is that the only way you have to know if they're getting the
message, and if they're getting the education that they need to
[inaudible]? Is that the only way you have to monitor?
DR. GERBERDING: We're not involving the clinicians in a surveillance
system, but we certainly know who we're training, and who's watching, and
how many of us are out on the trail giving lectures and continuing
education courses, slides, the Web. We have a number of media that are
involved in this, as well as many societies; for example, go to the
American Academy of Dermatology website because they have a phenomenal set
of images there to teach dermatologists about the clinical presentation of
the select agent.
So there are a lot of multi-media efforts going on.
DR. HUGHES: This is Jim Hughes. Just one additional, quick comment.
Your point is well-taken about the need to evaluate these approaches, and
we are developing plans to do that.
DR. JACKSON: This is Dick Jackson.
I just want to add that one thing, that it is important to do the
cognitive training, to give people information. It is also important to
take people through the drills and give them the experience of how you
respond, particularly in a chaotic and difficult situation, and we are
planning both that kind of emergent training for our own senior staff, and
that will happen very, very soon, as well as extensive training for 600 to
1,000 state, city and local leaders for the management working with
emergency response agencies and the medical community.
QUESTION: What about the public [inaudible]?
CDC MODERATOR: We do just have time for one more question from the
telephone. Please keep in mind that if you have any remaining questions,
just call our Press Office, and we'll connect you to the people you need
to talk to.
Next question from the telephone?
AT&T OPERATOR: That'll be from John Lauerman [ph] with Bloomberg News.
Go ahead, please.
QUESTION: Hi. Thanks very much for having this.
Today, Secretary Thompson said that he felt that HHS was quite
well-prepared to deal with a bioterrorist event. Since we're sort of
assessing, in a way, where we are, I'd like you to, if possible, talk
about whether by using a percentage number or using other qualitative
description of where we are right now. Obviously, we're farther along than
we used to be, but how close are to where we need to be?
DR. GERBERDING: Well, I agree with Secretary Thompson. I think we are
quite well-prepared, but I know he's also said that we're not done yet,
and we can always continue our preparedness efforts, and we intend to do
It's not something that can be quantified with a number or a scale.
Preparedness is not all or none, it's a continuum, and we will continue to
make investments and work aggressively to do as much as we can, as fast as
we can, scaling up, speeding up and streamlining.
CDC MODERATOR: That concludes our briefing today. We really appreciate
your coming, and please call us if you have more questions.