Testimony
of Margaret A. Hamburg, M.D.
Vice President of Biological Programs, Nuclear Threat Initiative
Senate
Committee on Governmental Affairs, Subcommittee of International
Security, Proliferation and Federal Services
October 17, 2001
Mr.
Chairman and members of the Committee, thank you for the
invitation to discuss the need to enhance our nation ’s capacity
to respond to the threat of biological terrorism.
Your leadership and commitment in addressing this challenge
comes at a critical time.
The tragic attacks last month have been a powerful reminder of our
nation’s vulnerability to terrorism, and have increased fears
that we could face even more devastating assaults in the future,
including the possible use of biological weapons.
Certainly, the events of recent days have underscored how
seriously we must take this emerging threat. Whether an
unsophisticated delivery system with a limited number of
exposures, as we have seen in several American cities, or the
potential of a more high-technology, mass casualty attack, the
prospects are frightening. Today,
no one is complacent about the possibility that a biological agent
might be intentionally used to cause widespread panic, disease and
death.
In this time of heightened anxiety and concern, our nation has a
real opportunity—and obligation—to make sure that we have in
place the programs and policies necessary to better protect
ourselves against this threat, and perhaps to prevent such an
attack from occurring in the first place.
While there are many challenges before us, we do know a
great deal about what needs to be done and how to do it.
I will address these issues in more detail later in my
testimony, but I want to emphasize at the outset that improving
the national response to bioterrorism must include several broad
elements, such as:
Prevention.
Every effort must be made to reduce the likelihood that dangerous
pathogens will be acquired or used by those that want to do harm.
This must include improving intelligence, limiting inappropriate
access to certain biological agents and efforts to establish
standards that will help prevent the development and spread of
biological agents as weapons;
Strengthening
public health. Rapid detection and response will depend on a well-trained cadre
of trained public health professionals to enhance disease
surveillance and outbreak investigation, educated and alert health
care providers, upgraded laboratories to support diagnosis, and
improved communications across all levels of government, across
agencies and
across the public and private sector.
Enhancing
medical care capacity. We must improve treatment for victims of an attack by enhancing
local and federal emergency medical response teams, training
health professionals to diagnose and treat these diseases,
developing strategies to improve the ability of hospitals to
rapidly increase emergency capacity, and providing necessary drugs
or vaccines where they are needed through a national
pharmaceutical stockpile.
Research.
A comprehensive research agenda will serve as the foundation of
future preparedness. Perhaps
most urgently, we need improved detectors/diagnostics, along with
better vaccines and new medications.
Some of these activities are already underway, but need to be
strengthened and extended; other programs and policies still need
to be developed and implemented.
This hearing represents an important forum to better define
the agenda we must pursue to be a nation prepared.
DARK WINTER EXERCISE
I have been asked in my testimony to address “Dark
Winter,” a recent bioterrorism exercise which involved the
intentional release of smallpox and the lessons learned. Although
a simulation of a worst-case scenario, it powerfully conveyed the
distinctive–and sobering–features of a potential bioterrorist
attack and helped to spotlight many of the vulnerabilities that we
must urgently and effectively address.
“Dark Winter” simulated a series of National Security Council
(NSC) meetings dealing with a terrorist attack involving the
covert release of smallpox in three American cities.
The exercise was conducted by the Center for Strategic and
International Studies, the Johns Hopkins Center for Civilian
Biodefense Studies, and the ANSER Institute for Homeland Defense,
under the leadership of John Hamre, Tara O’Toole and Randy
Larsen, respectively. Many
of the participants in “Dark Winter” had served previous
Presidents in cabinet or sub-cabinet positions.
Most knew how the NSC worked, and they were all individuals
with considerable expertise and perspective in the security, law
enforcement and health fields. I served as the Secretary of Health
and Human Services.
In
the opening minutes of “Dark Winter” we learned that cases of
smallpox had just been diagnosed by the Centers for Disease
Control. Given the propensity of this disease to spread
person-to-person, the 30% fatality rate of the disease, and the
limited supply of smallpox vaccine, it was not surprising that we
were soon dealing with an epidemic of devastating, if not
catastrophic, potential.
In the 20th century,
more than 300 million people died from smallpox – more than
those killed in all wars of the century combined.
Thanks to a massive and highly collaborative international
campaign, smallpox as a naturally occurring disease was
eradicated, and vaccination against the disease stopped.
Consequently, each passing year has seen the birth of new
generations of unvaccinated citizens, and a decrease in the
potency of previous vaccinations among adults. So although the
eradication of smallpox has saved thousands of lives, the end of
vaccination against it has paradoxically left the world more
vulnerable to the disease.
This fact would be of little consequence if we did not know that
smallpox was made into a weapon by the Soviet Union, and that
other nations or groups may have successfully acquired stocks of
the virus.
Today, a single case of smallpox anywhere in the world would
constitute a global medical concern. An example of the seriousness
of this disease is the wave of smallpox that was touched off in
Yugoslavia in 1972 by a single infected individual.
The epidemic was stopped in its fourth wave by quarantines,
aggressive police and military measures, and 18 million emergency
vaccinations, this to protect a population of 21 million that was
already highly vaccinated.
By comparison, in America today we have less than 15 million
effective doses of vaccine to protect a population of 275 million
that is highly vulnerable to the disease. The Yugoslavia crisis
mushroomed from one case; the “Dark Winter” exercise began
with 20 confirmed cases in Oklahoma City, 30 suspected cases
spread out in Oklahoma, Georgia, and Pennsylvania, and many more
individuals who were infected but not yet ill.
Initially, we did not know the time, place or size of the
release, so we had no way to judge the true magnitude of the
crisis. We could easily predict, however, that it would get worse
before it would get better.
Over a 24-hour period at Andrews Air Force Base, our NSC “war
gamers” dealt with three weeks of simulated shock, stress and
horror. We learned that on December 9, 2002, some dozen patients
reported to the Oklahoma City Hospital with a strange illness
confirmed quickly by the CDC to be smallpox.
While we knew only about the Oklahoma cases the first day,
we later learned the scope of the initial infections and the sites
of three simultaneous attacks in shopping centers in Oklahoma,
Georgia and Pennsylvania. The
initial infection quickly spread to five states and 3,000 victims,
although at this point, most infected individuals had not
displayed symptoms or gone to the hospital, so it was impossible
to tell who or where they were.
The two primary tools for containing a smallpox epidemic are
isolation of cases and vaccination of contacts.
In accordance with this, a strategy was devised to include
strict isolation of those with disease and a firewall of vaccine
protection around those cases, but from the beginning, that
strategy was limited by the large numbers of people initially
infected, the rapid spread of the disease, and our limited supply
of vaccine. Unfortunately,
we had only enough vaccine for one out of every 23 Americans.
(This remains the case in America today, although a contract is in
place and is being accelerated to produce at least 40 million new
doses by the end of 2002).
The Secretary of Defense demanded that all 2.3 million of U.S.
military personnel be immediately vaccinated wherever they were in
the world. In his
wisdom, the President decided against this policy. Instead, we
administered vaccine to U.S. military, including the National
Guard, and security and medical service personnel who were on the
front lines locally, and also those who were in areas of the world
where a smallpox attack was more likely to occur.
So, on the first night of decision-making, we designed the
vaccination strategy, and we ordered accelerated production of new
stock. We even asked the Secretary of State to try to find surplus
stock from other countries, but we were doubtful that they would
comply with our request in the face of a smallpox epidemic that
would in all likelihood become global.
On Day Six of the crisis, very little vaccine was left.
The situation required that we consider measures considered
draconian by modern standards, including enforced isolation,
restrictions on travel, and providing food and other essential
supplies to affected areas in the face of these restrictions.
These problems were exacerbated by the fact that, by this point,
we could no longer provide vaccine to essential providers.
On Day Twelve, when the war game ended, we were beginning the next
stage of the epidemic – those who caught smallpox from the
original 3,000 people who were infected in the initial terrorist
attack. Epidemiologic
models predicted that without effective intervention, every two to
three weeks the number of cases would increase ten-fold.
At the conclusion of the exercise, the epidemic had spread to 25
states and 10 foreign countries. Civil disorder was erupting
sporadically around the nation. Interstate commerce had ceased in
large areas of the country. Financial markets had suspended
trading. We were out of vaccine and were using isolation as the
primary means of disease control.
For each of us around the table, the lessons learned were somewhat
different, depending on our various backgrounds, experience and
expectations. It was
fascinating to see the differing perspectives that were brought to
bear on the same fundamental sets of data and decision-points.
At times, the old adage “what you see depends on where
you sit” came to mind. Yet
I think we all agreed that the exercise was indeed plausible -
even conservative - in the framing of the scenario and the
assumptions made about disease exposure, transmission and
treatment. Certainly,
we all left the room humbled by what we did not know and could not
do, and convinced of the urgent need to better prepare our nation
against this gruesome threat.
In my role as the Secretary of Health and Human Services, the
perspective I brought to the table was that of someone who served
first as a local health officer (New York City Health
Commissioner) and then as a federal public health official
(Assistant Secretary for Planning and Evaluation, Department of
Health and Human Services). I
felt first hand the devastation of terrorism as New York City’s
Health Commissioner when the World Trade Center was first bombed
in 1993. Today, the horror of that event is dwarfed by the attacks
of September 11th.
Yet despite the incredible scale of these attacks, it is
clear that an attack with a biological weapon has the potential to
inflict even greater damage upon our country, both in terms of the
extended timescale of the unfolding disaster and the numbers of
people affected.
I should state that my bias is to approach the bioweapons issue in
the broader context of infectious disease threats, both naturally
occurring and intentionally caused.
There is a continuum.
A bioterrorist attack such as that depicted in “Dark
Winter” would certainly represent the extreme end of that
continuum, both in terms of its potentially catastrophic
consequences for health and because of the disruption and panic
that it would cause.
ISSUES RAISED BY DARK WINTER EXERCISE
“Dark Winter” raised many important issues and provided an
opportunity to enhance awareness about the complexities of a
bioterrorist attack. It
served as a compelling illustration of just how much an attack
caused by biological weapons would differ from conventional
terrorism, military strikes or even attacks caused by other
weapons of mass destruction.
It demonstrated how such an attack would unfold slowly - over
days, weeks, months - as an infectious disease epidemic, with the
potential to cause enormous suffering and death, as well as panic,
destabilization and quite possibly civil disorder.
There was little doubt that this would be a true public
health emergency, for which our nation is ill-prepared to respond.
Moreover, it showed how a bioterrorist attack would
represent a national security crisis of enormous proportions, yet
many of the traditional strategies to manage such an event would
not apply. For example, identification of the perpetrator, as well
as avenues for possible retaliation, might not be feasible.
“Dark Winter” also underscored the interwined legal,
ethical, political and logistical difficulties that attend
contagious disease containment and control.
“Dark Winter” further demonstrated how poorly current
organizational structures and capabilities fit with the management
needs and operational requirements of an effective bioterrorism
response. Responding
to a bioterrorist attack will require new levels of partnership
between public health and medicine, law enforcement and
intelligence. However,
these communities have little past experience working
together and vast differences in their professional cultures,
missions and needs. The “Dark Winter” scenario also
underscored the pivotal role of the media, and how a productive
partnership with media will be paramount in communicating
important information to the public and reducing the potential for
panic.
Another clear lesson that emerged from “Dark Winter” was that
effective response will also require stronger working
relationships across levels of government.
While national leadership, guidance and support will be
essential, it must be recognized that much of the initial crisis
response and subsequent consequence management will unfold on the
local level. “ On-the-ground” local providers--public health
and medical professionals, emergency response personnel, law
enforcement officials and government and community leaders--will
provide the foundation of the response and will deal with the
problem from the moment the first cases emerge until the crisis is
over.
The “Dark Winter” scenario also brought into bold relief the
fact that management of such a crisis would almost certainly occur
in the context of an already strained health care system and
severe limitations on certain critical resources, including
shortages of vaccine, hospital beds and isolation capacity.
CHALLENGES FOR THE FUTURE
As an exercise, “Dark
Winter” was not designed to provide answers, but rather to raise
critical questions and issues about our current preparedness to
address the bioterrorist threat - Certainly it achieved that goal,
but how do we begin to address these critical concerns?
Building on lessons learned from “Dark Winter” from the
perspective of public health and medicine, let me emphasize
several key challenges as we move forward.
(1)Focus on the real threat/strengthen public health.
In previous testimony before Congress, I have emphasized
the need to convince policymakers and the public that the threat
of bioterrorism is real. However,
the recent cases of anthrax in Florida and New York City have made
this point more forcefully than I ever could. However, even in the context of current events, I believe
that a major challenge remains the need to get policymakers,
legislators, and program planners to really comprehend that the
threat of bioterrorism is fundamentally different than the other
threats we face, such as “conventional” terrorism, or attack
with a chemical or nuclear weapon.
Meaningful progress against this threat depends on understanding
it in the context of an infectious and epidemic disease.
It requires different investments and different partners.
Until bioterrorism’s true nature as an epidemic disease event is
fully recognized, our nation's preparedness programs will continue
to be inadequately designed: the wrong first responders will be
trained and equipped; we will fail to fully build the critical
infrastructure we need to detect and respond; the wrong research
agendas will be developed; and we will never effectively grapple
with the long-term consequence management needs that such an event
would entail.
Unfortunately, if we look at our current preparedness efforts to
date, necessary public health and medical care activities have
been underdeveloped and underfunded.
Of the roughly $10 billion budget for counterterrorism
efforts in FY 2001, only a very small percentage has supported
activities that truly can be considered as core elements of a
coherent program to address the bioterrorist threat. In the
current environment, it is clear that very substantial new monies
will be available, and we must ensure that a significant component
of those resources are targeted to address these critical
concerns.
(2) Build on existing strategies.
Effective strategies must build on existing systems where
possible, but build in flexibility. We do not want to develop an
entire ancillary system for responding to the bioterrorist threat.
Rather, we should strive to integrate our thinking and
planning into the continuum of infectious disease threats and
potential disasters that public health agencies are already
charged to respond to. The last thing we want is to find ourselves trying out a plan
for the very first time in the midst of a crisis.
Instead, we want to find the systems that work in routine
activities and then identify what we need to do to amplify or
modify them to be appropriately responsive for these more acute
and catastrophic situations.
(3) Support the health care system’s capacity for mass
casualty care . Controlling
disease and caring for the sick will require a deep engagement of
the public health and medical community.
There are currently many pressures on health care providers
and the hospital community that limit their ability to prepare in
some of the critical ways necessary for effective planning in the
face of the bioterrorist threat. The enormous downsizing that has occurred, the competitive
pressures to cut costs, the just-in-time pharmaceutical supplies
and staffing approaches, and the limited capacity for certain
specialty services such as respiratory isolation beds and burn
units that may become critical in a biological or chemical
terrorist attack, all need to be recognized and addressed.
We must be realistic about the potential costs that would be
incurred by these institutions and individuals, as well as the
enormous up-front investments needed if they are truly to prepare.
And in many ways, if you are a health care institution
today, making those preparatory investments is a high-risk
undertaking. By
preparing, you are also almost setting yourself up to incur a
series of costs that may not be reimbursed after the crisis is
over.
We know that we must find better ways to strategically support our
health care institutions, both because of the implications of a
bioterrorist attack but also because of the existing demands on
the system, as evidenced this past year when a routine flu season
overwhelmed hospital capacity in several cities.
There is an urgent need to develop programs that target dollars
for health care disaster planning and relief, including training,
templates for preparedness, and efforts to develop strategies in
collaboration with other critical partners for providing ancillary
hospital support in the event of a crisis.
This could be done either through the army field hospital
model or what was done in the 1918 pandemic flu, when armories,
school gymnasiums and the like were taken over to provide medical
care. In doing this, we need to support local and state planning
efforts to assess community assets and capabilities, and we need
to look at what federal supports can be brought to bear locally in
a crisis.
(4) Invest in research.
Today’s investment in research and development will be
the foundation of tomorrow’s preparedness.
A comprehensive research agenda should be developed and
pursued that extends across many important research domains.
For example, our capability to detect and respond to a
bioterrorist attack depends largely on the state of the relevant
medical science and technology.
Without rapid techniques for accurate identification of
pathogens and assessment of their antibiotic sensitivities,
planning for the medical and public health response will be
significantly compromised. Without
efficacious prophylactic and treatment agents, even the best
planned responses are likely to fail.
Biomedical research is needed to develop new tools for
rapid diagnostics, as well as improved drugs and vaccines.
At an even more basic level, we must invest in research to
enhance the fundamental study of genomics, disease pathogenesis
and the human immune response.
In addition to biomedical research, further research into such
diverse concerns as defining appropriate personal protective gear
or decontamination procedures under different circumstances will
be important to our overall preparedness for a bioterrorist
attack.
Research to support deeper understanding of the behavioral issues
and psychosocial consequences of a catastrophic event of this kind
is currently very limited but should be made a high priority. I believe that the importance of all of these areas has been
underscored by our recent experience in responding to the mounting
set of anthrax cases and exposures.
These events have demonstrated critical gaps in our
knowledge as well as deficiencies in our tools for detection,
response and consequence management that we can and should swiftly
address.
5) Understanding the public response. Sadly, the many
fears, anxieties and uncertainties that have surrounded the
current anthrax scare reinforce another major gap identified in
current preparedness and planning efforts.
This involves how to engage the public, and importantly,
how to most effectively work with the public in the event of a
crisis. The recent
small-scale anthrax attacks, although they have sickened only a
handful people, have given new insights into how complex these
issues may be. Certainly, the specter of a silent, invisible
killer such as an infectious agent evokes a different level of
fear and panic than other disaster scenarios. Indeed, response to previous major disease epidemics—such
as the outbreak of pneumonic plague in Seurat, India in
1994—suggests a level of panic and civil disruption on a far
greater scale.
Anyone who has ever dealt with disaster response knows that how
the needs of the public are handled from the very beginning is
critical to the overall response.
In the context of a biological event, this will no doubt be
even more crucial. Managing the worried well may interfere with
the ability to manage those truly sick or exposed. In fact,
implementation of disease control measures may well depend on the
constructive recruitment of the public to behave in certain ways,
such as avoiding congregate settings or following isolation
orders. In the final
analysis, clear communication and appropriate engagement of the
public will be the key to preventing mass chaos and enabling
disease control as well as critical infrastructure operations to
move forward. Correspondingly,
the needs and concerns of response personnel, including health
care workers, must also be addressed.
Again, prior experience with serious infectious disease
outbreaks tells us that when this does not occur, essential
frontline responders and key workers are just as likely as the
public to panic, if not flee. The mass exodus of health care
workers following onset of the Ebola epidemic in Kikwit, Zaire in
the mid 1990s serves witness to this point.
(7). Engage the media.
The media is key to efforts in a crisis to communicate
important information to protect health and control disease, as
well as to reduce the potential for panic. Over the past days, we
have seen both the press and the public receive a crash course on
anthrax. They have been fast learners, and for the most part, the
media has done a credible and responsible job in communicating
this important information. But there must be a clear plan for
providing the news media with timely and accurate information.
Furthermore, the credible and consistent voice of
well-informed health officials is critical to this effort.
Stepping back, it is clear that the ability of the media to
mobilize effectively in a crisis is greatly enhanced by a process
of ongoing and continuing mutual communication and education in
calmer times. We must strive for the development of a set of
working relationships grounded in trust - trust that they will be
provided with information in a timely and appropriate manner, and
in turn, that they will use that information in a responsible,
professional way.
No doubt there will always be tensions between the desire to get
out a good story and an appreciation of the complexities,
sensitivities and uncertainties inherent in such a crisis. But
stonewalling the press or viewing them as the enemy is virtually
guaranteed to make the situation worse.
(8) Clarify legal authorities. In planning for an effective
response, an array of legal concerns need to be addressed.
Issues include such basic ones as the declaration of
emergency ‑‑ what are the existing authorities?
Are they public health, or do they rest in other domains
that will be relevant? What
are the criteria for such a declaration?
What are the authorities that still need to be established?
Other outstanding legal questions concern the ability to isolate,
quarantine, or detain groups or individuals; the ability to
mandate treatment or mandate work; restrictions on travel and
trade; the authority to seize community or private property such
as hospitals, utilities, medicines, or vehicles; or the ability to
compel production of certain goods.
Also, questions concerning emergency use of pharmaceuticals
or diagnostics that are not yet approved or labeled for certain
uses need to be answered.
These questions involve many different levels of government, many
different laws and authorities, and raise many complex and
intertwined ethical, political and economic issues.
In a systematic and coherent way, we must address this
array of pressing issues and concerns. And not just what laws are
in place or could be put in place, but then also what policies and
procedures would be necessary to actually implement them.
(9) Plan, prepare and practice. Perhaps most fundamentally,
“Dark Winter” signaled the need for more planning and
preparation—across all the domains mentioned above and more.
Planning can make a difference, but we cannot begin to
prepare in the midst of a crisis.
As “Dark Winter” unfolded, it was evident that a sense
of desperation about what needed to be done arose, at least in
part because the country had not produced sufficient vaccine; had
not prepared top officials to cope with this new type of security
crisis; had not invested adequately in the planning and exercises
needed to implement a coordinated response; and had not educated
the American people or developed strategies to constructively
engage the media to educate people about what was happening and
how to protect themselves.
Prior
planning and preparation can greatly mitigate the death and
suffering that would result from a serious bioweapons attack.
As a nation, we need comprehensive, integrated planning for
how we will address the threat of bioterrorism, focusing both on
prevention and response. We need to define the relative roles and
responsibilities of the different agencies involved, and identify
the mechanisms by which the varying levels of government will
interact and work together. We
need true national leadership to address the bioweapons threat to
our homeland. Planning
efforts must be backed by the necessary resources and authority to
translate planning into action.
Moreover, we must practice what we plan.
Preparations must be exercised, evaluated and understood by
decision-makers if they are to prove useful in a time of crisis.
(10) The importance of prevention
. The many
intrinsic challenges involved in mounting an effective response to
a bioterrorism attack - and the many casualties that will
inevitably occur--should compel us to make a greater commitment to
what can be accomplished to reduce the fundamental threat of their
use. Clearly,
measures that will deter or prevent bioterrorism will be the most
cost effective means to counter such threats to public health and
social order - both in human and economic terms.
Are there strategies to limit or prevent these often
frightening microbes from getting into the hands
of those who might misuse them, and how do we reduce the
likelihood that they would be misused?
On a policy level, such prevention efforts require a global
approach, including the need to find ways to meaningfully
strengthen and enforce the Biological Weapons Convention, as well
as international scientific cooperation to create opportunities
for scientists formerly engaged in bioweapons research to redirect
their often considerable talents and energy into more constructive
and open research arenas. For
example, a number of scientific collaborations have begun in
Russia in an attempt to address this goal.
We must also strengthen and expand efforts to control access to
and handling of certain dangerous pathogens, including proactive
measures by the scientific community to monitor more closely the
facilities and procedures involved in the use of such biological
agents.
THE NUCLEAR THREAT INITIATIVE—A New Foundation
Encouraging and supporting our government to deter, prevent,
and defend against biological terrorism is
a central part of our mission at the Nuclear Threat
Initiative (NTI) – an organization founded by Ted Turner and
guided by a distinguished board co-chaired by him and former
Senator Sam Nunn. We
are dedicated to reducing the global threat from biological,
nuclear, and chemical weapons by increasing public awareness,
encouraging dialogue, catalyzing action, and promoting new
thinking about these dangers in this country and abroad.
We
fully recognize that only our government can provide the
leadership and resources to achieve our security and health
priorities. But
within that context, NTI is:
Seeking ways to
reduce the threat from biological weapons and their consequences.
Exploring ways to increase education, awareness and communication
among public health experts, medical professionals, and
scientists, as well as among policy
makers and elected officials – to make sure more and more people
understand the nature and scope of the biological weapons threat.
Considering ways
to improve infectious disease surveillance around the globe –
including rapid and effective detection, investigation, and response. This is a fundamental defense against any infectious disease
threat, whether it occurs naturally or is released deliberately.
Stimulating and
supporting the scientific community in its efforts to limit
inappropriate access to
dangerous pathogens and to establish standards that will help
prevent the development and spread of biological agents as
weapons.
And finally, NTI is searching for ways to help our government and
the Russian government to facilitate the conversion of Russian
bioweapons facilities and know-how to peaceful purposes, to secure
biomaterials for legitimate use or destruction, and to improve
security of dangerous pathogens worldwide.
CONCLUSION
In conclusion, let me re-emphasize that a sound strategy for
addressing bioterrorism will need to be quite different from those
that target other types of terrorist acts.
While a large-scale event most likely remains a relatively
low probability event, the high consequence implications of
bioterrorism place it in a special category that requires
immediate and comprehensive action.
Yet as we move forward to address this disturbing new
threat, it is heartening to recognize that the investments we make
to strengthen the public health infrastructure, to improve medical
consequence management and to support fundamental and applied
research, will also benefit our efforts to protect the health and
safety of the public from naturally occurring disease.
To be effective, we will need to define new priorities, forge new
partnerships, make new investments to build capacity and
expertise, and support planning. We may never be truly prepared
for some of the most catastrophic scenarios, but there is a great
deal that can and should be done.
I
look forward to working with you on these important issues and
would be happy to answer any questions you may have.
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