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U.S. Response I: States Submit Bioterrorism Plans to Health Agencies By Greg Seigle While Health and Human Services Department officials have not yet had time to review the plans because they just arrived, the 46 strategies appear to be wide-ranging and disparate, Thompson said after testifying at a Senate Governmental Affairs Committee hearing. The other four states — Minnesota, Montana, Texas and Utah — have been granted extensions to complete their plans, as have eight U.S. territories: American Samoa, Guam, Marshall Islands, Micronesia, North Mariana Islands, Palau, Puerto Rico and the Virgin Islands, according to a department document Thompson gave GSN. The department granted Utah an extension until July 1 because health officials there had been devoting their attention to the recent Winter Olympics, while the other states and territories have until May 15 to submit bioterrorism plans, Thompson said. All U.S. states and territories have already received the first 20 percent of the $1.1 billion (see GSN, Feb. 15). If Thompson approves the plans of the 46 states that have already filed, as he hopes to do by mid-May, then they would each begin receiving its portion of the remaining 80 percent, he said. “Who knows, I might not approve them” or the plans of “some states might need more work,” he told GSN. Plans Undergoing Scrutiny Each plan on how state and local authorities would respond to a biological weapons attack is supposed to be geared to fitting into a national strategy, Thompson told senators. “We’re hopeful that [with] this planning process and the $1.1 billion that we will be sending out, that we can build a local and state public health system that’s national in scope, that will be able to handle a bioterrorism attack,” Thompson said. Each plan, which much first be endorsed by the state or territory’s governor, is sent simultaneously to the Centers for Disease Control and Prevention and the Health Resources and Services Administration, according to Health and Human Services spokesman Bill Pierce. Both agencies are examining different aspects of the plans — the CDC is reviewing sections that address public health agencies while the HRSA is assessing parts that deal with hospitals, Pierce said. Once the plans clear the CDC and HRSA, they are sent to the department’s Office of Public Health Preparedness, headed by D.A. Henderson, where they undergo further scrutiny, Pierce said. Once Henderson backs the plans they will be presented to Thompson for final approval, he said. Analysts and officials have noted that it is key for various states and cities to design a solid foundation of bioterrorism response capabilities because the $1.1 billion this year is merely a “down payment” for a series of annual cash infusions to improve preparedness. Overall this year Health and Human Services is putting $2.9 billion into bioterrorism programs, much of it geared to give firefighters, police, doctors and other emergency crews the basic capabilities to respond to and handle a biological attack. Another $4.3 billion is slated for next year in the fiscal 2003 White House budget proposal, which Congress appears likely to approve, perhaps even increase. Senator Concerned About “Tug of War” Senator Max Cleland (D-Ga.), chairing yesterday’s hearing, expressed concern of a “tug of war” between health and law enforcement officials over who controls a response to a biological attack. “Turf battles,” including the compartmentalization of information in each of the more than 20 federal health and law enforcement agencies involved in bioterrorism preparedness, could hinder a response to an attack, Cleland said (See GSN, Feb. 12). “I think we have a problem,” Cleland said, noting that the nature of law enforcement officials is to be secretive, while public health officials aim to be open, a discrepancy that can be dangerous if the public needs to know some vital information about a bioterror attack. Thompson acknowledged some difficulties between the two camps but said relations have been improving in recent months. CDC officials meet with FBI counterparts every week — the CDC actually has a liaison at FBI headquarters full-time — and Thompson himself meets with FBI Director Robert Mueller every month, he said. “There seems to be some confusion of roles of various law enforcement and public health agencies,” Thompson said, adding that the confusion is particularly troublesome at the federal level. “If we can sit down with the Department of Justice and the Office of Homeland Security we can work it out.” Getting Supplies Quickly Senator Jim Bunning (R-Ky.), wondered if rural areas’ bioterrorism responses would be as swift as those in cities or large towns and was given assurance by Thompson that they would. “That’s why we divided the country up, into medical assistance teams, individuals we can activate quickly” to send supplies in on short notice, Thompson said. “That’s why we’ve expanded our push packages from eight to 12, our medical supplies — our medicines, our medical equipment — from 400 tons to 600 tons, and we have reduced the time from 12 hours hopefully down to seven or eight hours,” Thompson continued (see GSN, Jan. 29). “We can get 50 tons of medical supplies into Kentucky within five to six hours after an event,” he said. “That’s the plan we’re working on right now … We’ve got to make sure that the local individuals are going to be able to use that equipment, use the medical supplies, when we get it to individuals quickly.” Some analysts, however, have questioned whether or not rural areas — particularly those that do not have water supplies, electric plants or agricultural fields — should be given as much consideration as heavily populated areas. Cities like New York and Washington “need special capacities, to be much more robust in their ability to respond to a mass casualty situation than a smaller town,” Tara O’Toole, director of the Johns Hopkins Center for Civilian Biodefense Strategies, told GSN recently. “The national policy ought to be, ‘OK, if we think there are places that are specific targets for whatever reason — either because they are home to national symbols or they are especially vulnerable because they are ports or something, they should get extra money and special attention. That ought to be the policy.”
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