CDC Agroterrorism and Zoonotic Threat Preparedness Efforts
Committee on Homeland Security, Subcommittee on Prevention of Nuclear and Biological Attack, United States House of Representatives
Thursday, August 24, 2006
Lonnie J. King, D.V.M.
Centers for Disease Control and Prevention
U.S. Department of Health and Human Services
Good afternoon, Chairman Linder and Members of the Subcommittee. I am Lonnie King, the Centers for Disease Control and Prevention′s (CDC) Senior Veterinarian, and I am leading the effort to form a new center at CDC focusing on zoonotic, vector-borne, and enteric diseases. I am pleased to be here today to describe CDC′s preparedness efforts to prepare for and respond to agroterrorism and zoonotic threats. Before I begin, I would like to briefly mention the significant investments in research, laboratory, public health and hospital surge capacity our nation has made in recent years to protect the American people from naturally-occurring or terror-related threats. The President′s FY 2007 Budget includes a four percent increase in bioterrorism spending for a total budget of $4.4 billion, an increase of $178 million over last year′s level. This increase will enable us to accomplish a number of important tasks. The Department of Health and Human Services (HHS) will improve our medical surge capacity; increase the medicines and supplies in the Strategic National Stockpile; support a mass casualty care initiative; and promote the advanced development of biodefense countermeasures to a stage of development so they can be considered for procurement under Project BioShield.
We also continue to prepare against a possible pandemic influenza outbreak and appreciate your support of $2.3 billion for the second year of the President′s Pandemic Influenza plan, in the FY 2006 Emergency Supplemental Appropriations Act for Defense, the Global War on Terror, and Hurricane Recovery. The President′s FY 2007 budget also provides more than $350 million for important ongoing pandemic influenza activities such as safeguarding the Nation′s food supply, global disease surveillance, and accelerating the development of vaccines, drugs, and diagnostics.
Finally, it is important to note that HHS funding to enhance State and local preparedness for public health emergencies, including pandemic influenza, has existed since 2001. Principally through CDC and the Health Resources and Services Administration (HRSA) funds have been provided to States and localities to upgrade infectious disease surveillance and investigation, enhance the readiness of hospitals and the health care system to deal with large numbers of casualties, expand public health laboratory and communications capacities and improve connectivity between hospitals, and city, local and state health departments to enhance disease reporting. Including the funding we have requested for FY07, CDC′s and HRSA′s total investments in State and local preparedness since 2001 will total almost $8 billion.
Infectious diseases are a continuing threat to our nation′s health. Although modern advances have conquered some diseases, the outbreaks of Severe Acute Respiratory Syndrome (SARS), avian influenza, West Nile virus (WNV) infection, and monkeypox are recent reminders of the extraordinary ability of microbes to adapt and evolve. Earlier predictions of the elimination of infectious diseases often did not take into account changes in demographics and human behaviors and the ability of microbes to adapt, evolve, and develop resistance to antimicrobial drugs. In 2003, the Institute of Medicine (IOM) issued a report, “Microbial Threats to Health: Emergence, Detection, and Response,” that outlined recommendations on critical issues facing the prevention and control of microbial threats to human health. The IOM described thirteen factors involved in the emergence of infectious diseases. A majority of these factors included agricultural or animal health issues that inevitably affect human health. The report also recognized the growing threat from diseases transmitted by an animal vector and zoonotic diseases—diseases that can be transmitted from animals to humans. The emergence of SARS in 2003 demonstrated that U.S. health and global health are inextricably linked and that fulfilling CDC′s infectious diseases mission – to prevent illness, disability, and death caused by infectious diseases in the United States and around the world – requires global awareness and a focus on the overlap of animal and human health.
It is estimated that 75 percent of emerging pathogens are zoonotic in origin. High-priority bioterrorism agents (Category A agents) include organisms that pose a risk to national security because they can be easily disseminated or transmitted from person to person, result in high mortality rates, and have the potential for major public health impact. Five of the six CDC Category A potential agents of bioterrorism are zoonotic. Agroterrorism is the threat of or deliberate introduction of an animal or plant disease that would impact U.S. food systems. CDC would become involved in a response if an animal disease were introduced that affected human health. Vectors, such as insects or ticks, are among the most common conduits for disease transmission from animals to humans. Diseases transmitted by vectors are especially difficult to control, as demonstrated by the rapid spread of West Nile virus, which has so far infected more than 1.2 million Americans. Other examples of vector-borne diseases include plague, tularemia, and many hemorrhagic viruses, like Rift Valley fever. Current examples of this risk are the epidemic of chikungunya virus in the Indian Ocean, the jump of Rift Valley fever from Africa to Saudi Arabia, and outbreaks of dengue along the U.S.-Mexican border. While it is difficult to predict when and where the next zoonotic event will occur, all the critical factors are in place to ensure that this new era of emerging zoonoses—naturally or intentionally caused—will continue or even accelerate in the future.
HHS and CDC Role in Agroterrorism Preparedness and Zoonotic Diseases
The health and security of the United States depends on our preparedness against terrorism, including agroterrorism, as well as other public health emergencies including the threats of zoonotic and vector-borne diseases. These threats necessitate that we improve our public health and medical systems so that we can respond with greater flexibility, speed, and capacity in coordination with state and Federal partners. As SARS and avian influenza have taught us, animal health strategies impact public health, and the strategies to protect both should be coordinated. Because animals and people are inextricably linked, the possibility for exposure to zoonotic diseases is unprecedented and presents new levels of threat and vulnerability.
HHS is responsible for leading Federal public health efforts to ensure an integrated and focused national effort to anticipate and respond to emerging threats from agroterrorism and zoonotic diseases. Within HHS, CDC is gaining a better understanding of zoonotic disease emergence, prevention, and control from quality research. By partnering with other Federal agencies that focus on animal health and with state governments and academic and private institutions, CDC is addressing preparedness for an agroterrorism event due to a zoonotic disease.
Most notably to the public, HHS and CDC are leading the nation in the area of avian influenza preparedness. This work fits within the framework of the National Strategy for Pandemic Influenza Implementation Plan published on May 3, 2006, by the White House Homeland Security Council (HSC), and involves ongoing coordination with the Department of Homeland Security (DHS) and the Department of State (DOS).
National Center for Zoonotic, Vector-Borne, and Enteric Diseases (proposed)
While CDC′s activities in avian flu preparedness are the most publicized, they represent only one part of CDC′s comprehensive activities related to agroterrororism and zoonotic diseases. Importantly, CDC is proposing a new organizational unit, the National Center for Zoonotic, Vector-Borne, and Enteric Diseases (NCZVED), which will bring together similarly focused programs and provide national and international scientific and programmatic leadership for zoonotic, vector-borne, foodborne, waterborne, mycotic, and related infections to identify, investigate, diagnose, treat, and prevent these diseases. In carrying out its mission, NCZVED will provide leadership, expertise, and service in laboratory and epidemiological science, bioterrorism preparedness, applied research, disease surveillance, outbreak response, policy development, health communication, education and training, and program implementation and evaluation. NCZVED will focus on the continuing challenge of emerging and re-emerging zoonoses and recognize the importance and need to work collaboratively, not just across CDC and the traditional public health community but also with agricultural, wildlife, and companion animal agencies and organizations.
Surveillance and Epidemiology
A possible target of agroterrorism is the nation′s food supply. Surveillance of and epidemiologic response to disease are the foundation of CDC′s activities. Preparedness for naturally occurring outbreaks better prepares the United States for the unexpected attack. Routine disease surveillance systems coordinated by CDC provide an essential early-information network to detect dangers in the food supply. In addition, these systems can be used to indicate new or changing patterns of foodborne illness and would likely detect early cases of an agroterrorism event involving a zoonotic agent. For example, PulseNet is a national network of public health and food regulatory agency laboratories coordinated by CDC and consists of State health departments, local health departments, the U.S. Department of Agriculture (USDA), and HHS′s Food and Drug Administration (FDA). PulseNet plays a vital role in surveillance for and investigation of foodborne illness outbreaks that were previously difficult to detect. Participants perform standardized molecular subtyping (or “fingerprinting”) of foodborne disease-causing bacteria which are submitted electronically to a dynamic database at CDC.
This database is available on demand to participants which allows for rapid comparison of the patterns. When similar DNA patterns are identified for foodborne disease-causing bacteria, scientists can determine whether cases of illness are linked to the same food source, even if the affected persons are geographically far apart. Outbreaks can often be detected in a matter of days rather than weeks. As a consequence, CDC can more rapidly alert FDA and USDA about implicated food products associated with foodborne illness so that all three agencies can take protective public health action.
PulseNet works in tandem with CDC′s Foodborne Diseases Active Surveillance Network (FoodNet), a collaboration among state health departments, USDA, and FDA that closely monitors the human health burden of foodborne diseases in the United States. FoodNet consists of active surveillance for foodborne diseases and related epidemiologic studies designed to help public health officials better understand the epidemiology of foodborne diseases in the United States. These surveillance networks have led to improvement in the public′s health and stand prepared to detect an agroterrorism event in the food supply. For example, the incidence of E. coli O157 infections began to decrease sharply after 2002, as investigations of PulseNet-identified clusters focused attention on more specific controls at the level of ground beef. By 2004, the incidence of E. coli O157 infections as measured in FoodNet had dropped 42% since the baseline period of 1996–1998, and was below the goal for Healthy People 2010. Since much of our food today is imported, CDC has also emphasized the need for these systems to be more global and to expand to detect more zoonotic agents and diseases.
CDC also has partnered the public health system with veterinary and wildlife health partners at the Federal, state, and local levels in the creation of ArboNET, a comprehensive CDC-developed system to monitor West Nile virus and other mosquito-borne virus activity in the United States.
CDC is also working to build public health capacity abroad. With the help of FY 2006 Emergency Supplemental funds, CDC is establishing an on-ground regional presence with Global Disease Detection (GDD) Response Centers in five key global areas: Egypt, Guatemala, Kenya, Thailand, and PR China. This is part of CDC′s efforts to strengthen global surveillance capacity by establishing a network of Global Disease Detection and Response Centers strategically placed in each of the six WHO regions. Each GDD Response Center will design and implement key interventions aimed at the early identification and containment of pandemic health threats, whether an act of terrorism or the natural emergence of a deadly infectious pathogen like pandemic influenza.
A public health laboratory infrastructure that can provide test results in hours rather than days is critical in the event of a biological or chemical attack. The Laboratory Response Network (LRN) was created in 1999, by CDC, the Association of Public Health Laboratories (APHL), and the Federal Bureau of Investigation (FBI). The LRN is a national network of local, state and Federal public health, military, food testing, veterinary diagnostic, and environmental testing laboratories that provides the laboratory infrastructure and capacity to respond to biological and chemical terrorism and other public health emergencies. The approximately 150 laboratories in the LRN are affiliated with Federal agencies, military installations, international partners, and state and local public health departments.
Since its inception, partnerships with FDA, USDA, and others have helped to expand the LRN′s capacity. FDA′s Center for Food Safety and Applied Nutrition (CFSAN) and Office of Regulatory Affairs (ORA) have been working with the LRN on developing standardized food sample testing methods for use among Food Emergency Response Network (FERN) labs, some of which also operate as LRN-member laboratories. FERN is jointly operated by FDA and USDA. FERN laboratories would be critical in the recovery phase of an event by screening large numbers of food samples. In addition, the LRN is also working with USDA′s Animal and Plant Health Inspection Service (APHIS) laboratory in Ames, Iowa, and the veterinary diagnostic laboratory community to act as reference and sentinel laboratories for the detection of zoonotic agents.
To ensure accurate testing of food samples, the LRN and FERN have worked on test method harmonization for counter-terrorism purposes and have participated in joint proficiency testing exercises. The networks have conducted joint exercises for Bacillus anthracis, Francisella tularensis, and Shigella spp. in vulnerable food commodities. The LRN currently has 97 laboratoriess participating in food testing for select biothreat agents, and it has participated in the development of the FERN model for food surveillance testing and surge capacity.
Given that many Category A agents are zoonotic, the LRN has made an effort to include the veterinary diagnostic laboratory (VDL) community in the expansion of the LRN. The LRN currently includes nine VDLs, including the APHIS laboratory in Ames, Iowa. VDLs in the LRN provide a link between animal health and human health systems by conducting animal health surveillance for zoonotic agents and performing food testing. They also provide the LRN with surge capacity testing. The American Association of Veterinary Laboratory Diagnosticians is an LRN partner that helps recruit VDLs as LRN reference labs.
Laboratory capacity is further enhanced by Homeland Security Presidential Directive 9 (HSPD-9) which calls for nationwide laboratory networks for food, veterinary, and plant health that integrate existing federal and state laboratory resources and are interconnected. Specifically, HSPD-9 requires HHS and USDA to develop robust, comprehensive, and fully coordinated surveillance and monitoring systems that provide early detection and awareness of disease, pest, or poisonous agents. In response, CDC, FDA, and USDA created an interagency working group in late 2004 to begin the process of coordinating their networks for zoonotic disease surveillance. In 2005, the Department of Homeland Security formed the Integrated Consortium of Laboratory Networks (ICLN) to define the roles and responsibilities of each agency′s laboratory network. A memorandum of understanding is pending with FERN based on roles and responsibilities spelled out in the response matrix of the ICLN. The LRN is also working with the ICLN, USDA, and FDA on gap analyses of laboratory testing capacity for three biological agent scenarios, including avian influenza/human pandemic influenza. HSPD-9 also calls for the development of a National Veterinary Stockpile (NVS). CDC is participating on USDA′s advisory committee regarding the creation of the NVS.
Select Agent Program
The Public Health Security and Bioterrorism Preparedness and Response Act of 2002 and the Agricultural Bioterrorism Protection Act of 2002 (the Acts) require entities to register with HHS/CDC or USDA/ Animal and Plant Health Inspection Service (APHIS) if they possess, use, or transfer select agents or toxins that could pose a severe threat to public health and safety, to animal or plant health, or to animal or plant products. In addition to ensuring that laboratories safely handle these select agents and toxins, the Acts also require laboratories to adopt safeguards and security measures including controlling access, permitting the Attorney General to screen entities and personnel (i.e., security risk assessments) and establishing a national database of registered entities. The Acts also establish criminal and civil penalties for failing to comply with the requirements of the Acts.
“Overlap” select agents and toxins are those agents that have the potential to pose a severe threat both to public health and safety and to animal health or animal products and are subject to regulation by both agencies. The Acts require that CDC and APHIS coordinate activities in regard to “overlap” select agents and toxins so as to minimize conflicts between the regulations and activities carried out under the programs, minimize the administrative burden on the regulated community, ensure the appropriate availability of select agents and toxins for legitimate biomedical, agricultural or veterinary research, education or other such purposes, and ensure that information on entities possessing overlap select agents and toxins is available to CDC and APHIS via a single shared web-based system.
State and Local Preparedness
CDC′s Public Health Emergency Preparedness Cooperative Agreement provides funding to states, select metropolitan areas, territories, and other public health entities to develop emergency-ready public health departments by upgrading, improving, and sustaining their preparedness and response capabilities for “all-hazards” public health emergencies, including terrorism, pandemic influenza, and other naturally-occurring public health emergencies. These emergency preparedness and response efforts support the National Response Plan and the National Incident Management System. In addition, the Centers for Public Health Preparedness (CPHP) program was initiated by CDC in 2000, to strengthen terrorism and emergency preparedness by linking academic expertise to state and local health agency needs. This unique program brings together colleges and universities with a common focus on public health preparedness to establish a national network of education and training resources. CPHP Network activities enhance collaboration across the CPHP Network and with CDC, minimize duplication in development of materials, and maximize outreach of existing resources. All 50 states, plus the District of Columbia, Puerto Rico, and the Virgin Islands are served in some capacity (with at least one CPHP activity) through the 27 CDC-funded Centers located within accredited Schools of Public Health.
Several CPHPs have expertise in agroterrorism-related work. For example, Iowa State University College of Veterinary Medicine′s Center for Food Security and Public Health (CFSPH) was founded in July 2002, as a Specialty Center in Public Health Preparedness for Veterinary Medicine and Zoonotic Diseases. CFSPH integrates veterinary medicine and expertise in zoonotic diseases and public health with the ongoing activities and needs of preparing for emerging diseases.
CDC is adapting to meet the challenges presented by terrorism and emerging diseases. New strategies, innovations, and goals bring new focus to the agency′s work, allowing CDC to do even more to protect and improve health. CDC has developed four major overarching goals one of which is People Prepared for Emerging Health Threats. This goal will address scenarios that include natural and intentional threats with an emphasis on prevention and response to chemical, radiological, and emerging threats including zoonoses (e.g., influenza, anthrax, and plague).
Collaborations with Zoonotic Partners
World Organization for Animal Health
CDC was recently selected to become a World Organization for Animal Health (Office International des Epizooties, OIE) Collaborating Centre for Emerging and Re-emerging Zoonoses. In this role, CDC will be better equipped to forge stronger ties between the public health and animal health sectors to detect, control, and prevent zoonoses.
In addition, CDC will send a veterinary public health expert to OIE for a temporary assignment in fall 2006, to identify the most likely locations for “twinning” of laboratories, with an aim at stronger integration between animal and human health expertise, as well as establishment of longer term collaboration between selected locations in developing countries and well-established OIE Reference Laboratories. CDC will also support a similar assignment to the United Nations′ Food and Agriculture Organization in Italy.
CDC is also seeking ways to build the veterinary public health workforce internationally in countries for which CDC has traditionally recruited physicians and public health epidemiologists for applied public health training. CDC will incorporate fellowships for veterinarians into its existing Field Epidemiology and Laboratory Training Programs (FELTPs). Also, the director of CDC′s International Emerging Infections Program in Thailand will work with the OIE regional representative to explore the potential for building relationships in the region between CDC, Ministries of Health, and Ministries of Agriculture.
World Health Organization
CDC will also send a staff person to the WHO for a temporary assignment in fall 2006, to assist WHO′s Department of Food Safety, Zoonoses and Foodborne Diseases in determining the nature and extent of the assistance needed by Member States to meet the obligations of the International Health Regulation (2005) for animal- and food-related emergencies. The assignee will work with staff in charge of WHO surveillance systems to assess incoming reports of zoonotic and foodborne disease outbreaks and to identify the assistance needed such as increased surveillance, information exchange, technical cooperation, and capacity building.
American Association of Veterinary Medical Colleges
CDC works with the American Association of Veterinary Medical Colleges on curriculum development and fellowship opportunities to better prepare the veterinary workforce for addressing the animal-human health overlap. Fourteen veterinary colleges currently have public health programs and new courses are being developed that train and prepare veterinarians for bioterrorism, public health, and biomedical research careers. In addition, veterinarians serve in many roles in the public health workforce at CDC including participating in CDC′s Epidemic Intelligence Service and Emerging Infectious Diseases Laboratory Fellowship Program.
Council of Association Presidents
Integrating the food safety and food defense efforts of Federal, state, and local public health, veterinary and food safety officials is of critical importance. CDC is collaborating with FDA, USDA, and the Council of Association Presidents to raise awareness of current and emerging issues and to promote coordination. The Council comprises the ten leading public health, veterinary, and food safety associations that work the spectrum of food safety and food defense, from animal feed to human health. The collective expertise and collaboration of these associations are essential to develop and implement integrated efforts, provide needed training, and build the multi-disciplinary capacity necessary to address food-related emergencies.
At this time, the scope, scale, and consequences to human and animal health from zoonotic and agroterrorism threats are unprecedented. Preparing for zoonotic threats requires a merging of responsibilities at the animal-human interface, and this preparation is leading to significant progress in CDC′s ability to prepare for and respond to an agroterrorism event. Frequent collaboration on outbreak detection and response and close coordination among Federal and State food safety, public health, law enforcement, and intelligence-gathering agencies have resulted in enhancement to the nation′s public health systems. These systems improve our nation′s ability to respond to naturally occurring events and prepare the United States for a possible agroterrorism attack. Thank you for this opportunity to discuss our preparedness efforts.. I would be pleased to respond to any questions.