Good morning.  I’d like to thank my colleagues and several of our witnesses for traveling to be here today.  I’d also like to welcome our Rhode Island witnesses and guests – it’s an honor for me to be able to be able to tackle such an important issue here in my home state, and to have your expertise to guide our efforts. 

Today we will discuss the challenges states and localities face in preparing for, and responding to, emerging biological threats such as pandemic influenza that will affect every sector of society, and every person in the world.

Efforts to address biological threats are among the most difficult.  In fact, they are so challenging that for decades, planning for situations involving biological terrorism (using diseases such as smallpox), emerging infectious diseases (such as Ebola), and re-emerging infectious diseases (such as pandemic influenza) took a back-seat to planning for other situations where response would be more straightforward (such as terrorism or accidents involving chemicals). 

This has changed.  Our government no longer considers planning and preparedness for biological threats to be too hard, and we have effectively determined what we need to do to save lives – but more must be done.  We all remember the anthrax events of 2001.  Before and since then, there have been other biological incidents that made equally vivid impressions:

• Outbreak of SARS,
• West Nile Fever,
• XDR- and MDR-tuberculosis,
• Outbreaks of meningitis and mumps on college campuses,
• Superbugs such as MRSA and VRSA,
• Recent cases of salmonella and E. coli that have tainted our Nation’s food supply are only a few that have occurred here in the United States

Time and again, the public and private sectors have responded to these threats, but not without difficulty. 

Our nation prides itself on confronting the tough issues, and not shying away from a fight.  The citizens of Rhode Island exemplify this ethic, and it is because of them and others like them throughout our great nation that we are here today. 

It comes down to saving lives.  In the case of pandemic influenza and diseases caused by some agents of bioterrorism, in the best case scenario, we expect hundreds of thousands of people to become sick across the nation.  In the worst case scenario, hundreds of thousands could become sick in just one state or territory – like Rhode Island.  The price we would have to pay – in terms of lives, the economy, and society – is too great to make preparedness for these events a low priority. 

We have increased our readiness for any number of biological threats, and it is clear to me and my colleagues on this subcommittee that time, resources, and effort have gone into ensuring we are more prepared.  I know that those we have invited to provide testimony today would agree.  But we have to get beyond getting ready – we must actually be ready. 

We have established and added to federal and state stockpiles of drugs and equipment, but we are not ready yet.  We have engaged in planning efforts, but we are not ready yet.  We have done a great deal of research on developing methods that get us to new drugs and better treatments faster, but we are not ready yet.  We have increased communications between the public and private sectors, but we are not ready yet.  And although we recognize that difficult decisions will need to be made regarding the delivery of medical care when resources are short and patients number in the millions, we are not yet ready to make those decisions.   

There are many issues that need to be addressed, but among the most important are:

encouraging different sectors to partner with each other to counter these threats,
integrating efforts and increasing efficiencies in public health and emergency response to biological events, and
helping our health care professionals save as many lives as possible when resources are strained by a biological disaster. 

When it comes to large-scale issues – like diseases for which we have few or no treatments and which could sweep across the country and the world – it is clear that no one sector or entity is solely responsible for prevention, deterrence, preparedness, detection, response, recovery, or mitigation.  Different sectors must partner with each other – and the kind of partnerships that we need to see between the Department of Homeland Security and the Department of Health and Human Services, or the State Emergency Management Agency and the State Department of Health, are critical. 

There are hundreds, if not thousands, of efforts going on right now to address federal requirements for getting ready for a variety of different situations that would affect the health of the public.  We have talked about coordinating those efforts before, but we need to go from coordination to integration.  Public health and health care resources are limited, so the efforts of these sectors need to be as efficient as possible. 

This efficiency must be inherent in what the federal government is asking the non-federal public and private sectors to do, in the way grants and planning guidance go out to the states and territories, and in what it truly means to hold the states and territories accountable to the Executive Branch, and the Executive Branch accountable to Congress and the American people.

Decision-making when lives are at stake is difficult at best, especially when large numbers of people could be affected.  I realize that there are certain decisions that no leader wants to make, but emergencies, disasters, and catastrophes demand them of us.  To the greatest extent possible, we need to decide now what we are going to do when the number of people ill with a disease far exceeds the number of resources available to treat them. 

The federal government has issued some guidance in these and other areas, but we have not made enough headway.  Everyone needs to roll up their sleeves, work their way through these challenges, and develop decision-making criteria for those that will have to make the tough calls in the midst of a crisis. 

We must not back down from the fight against biological threats of any type– whether naturally-occurring or intentionally introduced by a terrorist.  And we can not let artificial situations – like boundaries between states and countries or a change in Administration – keep us from continuing that fight. 

I appreciate the efforts of the public and private sector witnesses here today.  Together we will address a number of issues, including partnering across sectors, creating greater efficiency in public health and other preparedness efforts, and making the most difficult decisions of all – those that affect the lives of our families, our friends, and our citizenry.