Mohammad N. Akhter, MD, MPH
Presented to the Senate Health,
Education, Labor and Pensions Committee
October 9, 2001 at 10:00 a.m.
Mr. Chairman and Members of the Committee, my name is Mohammad Akhter and I am the Executive Director of the American Public Health Association. I thank you and the members of the Committee for this opportunity to present you with our view on how to enhance the public health infrastructure so as to be better able to prevent, detect, and respond to a bioterrorist attack.
Mr. Chairman, we are, at best, unprepared to deal with a bioterrorist attack. We are able to deal with small events but are not in a position to deal with large ones. State and local health departments are not fully prepared to deal with an attack. Specifically,
1.) The public health community and the intelligence community have not been traditional partners in the past. Therefore, contacts between them have been very limited.
2.) Out of 3,000 local health departments, 10% do not even have e-mail capability, and many do not have adequate communication capability.
3.) Most health departments are 9 to 5 operations. If an incident takes place on Friday, there will be nobody at the health department to deal with it. The window of opportunity to save a person's life is very narrow and in most instances there is only 24-48 hours after an individual has been exposed to a bioterrorist agent that that individual can be successfully treated.
4.) There is a weak link between health departments and health care providers such as hospitals, the medical community, the EMS System, and in many cases, there is no link among them at all. Reporting to the health department is often very slow. Since early identification of an outbreak is the key event, these links need to be strengthened.
5.) There is a lack of the necessary epidemiological expertise as shown by the fact that one-half of the state health departments do not have an epidemiological intelligence office.
6.) There is a lack of adequate supplies of vaccines and antibiotics to deal with emergencies.
7.) Even if needed vaccines and antibiotics were available, most health departments do not have the capacity to distribute the antibiotics or to provide immunizations to a large number of individuals in the event of a terrorist attack. This was demonstrated yesterday in Florida where people had to wait several hours in order to receive antibiotics for possible exposure to anthrax.
8.) CDC lacks adequate capacity to deal with multiple events and with massively exposed populations.
9.) We lack hospital capacity to deal with large emergency situations. Patients in most hospitals must sometimes wait for hours in emergency departments for an available bed at the present time. We need to work with the Department of Defense to increase hospital capacity in the event of an emergency.
10.) Many state health departments have no laboratory or have inadequate laboratory capacity and capability to promptly diagnose infectious disease outbreaks.
11.) The training of primary care providers, doctors, nurses, and EMTs to prepare them to detect outbreaks is limited and needs to be greatly expanded. This is an area in which private sector organizations and associations can be of major assistance.
This is what I suggest that we do
1.) Establish regular contacts between the intelligence community and health departments, including monitoring of diagnostic laboratories by the intelligence community.
2.) Strengthen the infrastructure of public health at the Federal, state, and local levels to expand the capability for early detection of and rapid response to a bioterrorist attack, including building capacity as well as training of public health professionals.
3.) Enhance education and training of primary care and front line providers in the early detection of disease outbreaks.
4.) Protection of emergency workers and primary care providers and other security personnel, including immunizing them against small pox and anthrax, and making antibiotic treatment available to them promptly when needed. Having them wait in line to receive needed vaccines or antibiotics will keep them away from their duties in the case of an emergency.
5.) Thirty years ago, we made a decision to discontinue immunizations against small pox. This is the time to review that policy. Therefore, I recommend that there be a re-evaluation of the current policy regarding the immunization of civilian populations by a high level committee consisting of scientists and members of the intelligence community, in order to assess the risks and benefits of population-wide immunizations against common infectious agents as well as against likely bioterrorism agents, e.g., anthrax and small pox.
6.) Finally, expand research and development in order to improve the prompt detection and more effective prevention and treatment of individuals exposed to bioterrorists agents.