REP. SHAYS: I'd like to call this hearing to order and welcome our witnesses and guests.
A word of caution: Some of what we are about to see and hear is not for the squeamish, but the frightening, literally sickening, impact of a large-scale biological weapons attack on the United States has to be confronted on its own terms. Better to be scared by the improbable possibility than to be unprepared for the catastrophic reality.
The focus of our hearing today is a recent terrorism response exercise ominously named Dark Winter, during which the unimaginable had to be imagined; a multi-site, smallpox attack on an unvaccinated American populace. The scenario called upon those playing the president, the National Security Council and state officials to deal with the crippling consequences of what quickly became a massive public health and national security crisis.
The lessons of Dark Winter add to the growing body of strategic and tactical information needed to support coordinated counterterrorism policies and programs. Coming to grips with the needs of first responders, the role of the governor, use of the National Guard and the thresholds for federal intervention in realistic exercises vastly increases our chances of responding effectively when the unthinkable, but some say inevitable, outbreak is upon us.
The costs of an uncoordinated, ineffective response will be paid in human lives, civil disorder, loss of civil liberties and economic disruption that could undermine both national security and even national sovereignty.
If there is a ray of hope shining through Dark Winter, it is sparked by this irony: improving the public health infrastructure against a man-made biological assault today better prepares us to face natural disease outbreaks every day. Just as biotechnologies can be used to produce both lifesaving therapies and deadly pathogens, public health capabilities are likewise dual-use; enhancing our protection against smallpox attacks by a terrorist and an influenza epidemic produced by Mother Nature.
Let me welcome and thank our most distinguished witnesses this afternoon. Our first panel consists of key participants in the Dark Winter exercise. We look forward to testimony from Oklahoma Governor Frank Keating, former Senator Sam Nunn and their colleagues describing the critical path of decision-making during a spreading public health and public safety crisis.
Witnesses on our second panel will address the important role of National Guard and public health personnel in bioterrorism response. Like politics, all disasters are local, at least initially. State military units and public health professionals, among others, man the first line of defense against the consequences of a biological attack. Their perspective is important and we appreciate the time, talent and dedication they bring to our discussion this afternoon.
I'd like to recognize our first panel; the Honorable Frank Keating, governor of Oklahoma; the Honorable Sam Nunn, chairman and chief executive officer, Nuclear Threat Initiative, and former senator; Dr. John Hamre, president and chief executive officer, Center for Strategic International Studies; Dr. Margaret Hamburg, vice president, biological programs for the Nuclear Threat Initiative; and Mr. Jerome Hauer, managing director, Kroll Associates.
I think, as you know, it is our practice to administer the oath in this committee and I just invite you all to stand. Raise your right hand.
Do you solemnly swear or affirm that the testimony you will give before the subcommittee will be the truth, the whole truth and nothing but the truth?
Thank you very much.
You know, I was thinking we have sworn in every one in my entire seven years as chairman except one person, Senator Byrd. I chickened out, Senator Nunn, when Senator Byrd came. But I realize it's both an honor to testify, I think, on this important issue and others and I appreciate you being willing to be sworn in.
At this time we'll start with you, Governor Keating, and then -- oh, I'm sorry, we have -- you're in charge.
HAMRE: Well, I'm not in charge, sir, but I'm just trying to stay ahead of this bunch, that's all I'm trying to do.
SHAYS: OK. Well, as far as I'm concerned, you have the floor, sir. You're in charge.
HAMRE: Thank you, Mr. Chairman.
It's a real privilege. And my role here today is really simply to summarize enough of the exercise so that you feel you could sit today back in the chair when we met about a month ago and what was going on in everybody's head so that you can appreciate the very powerful message. And if I could ask us to go to the opening chart.
SHAYS: Now, I understand that there might be some graphic display here.
HAMRE: Sir, there will be graphics as well as some video and it will all be shown up on these side monitors.
SHAYS: And I'm told that some of it isn't pleasant; is that right?
HAMRE: It's not pleasant, and let me also emphasize, sir, this is a simulation. This had frightening qualities of being very real and, as a matter of fact, too real. And because we have television cameras here broadcasting, we want to tell everyone this did not happen. It was a simulation, but it had such realism and we're going to try to show you the sense of realism that came from that today.
Why don't we go to the next chart, if I may, please?
If I could, while we are waiting, let me just say that there were three institutions that collaborated on this project: the Center for Strategic International Studies; the Johns Hopkins Center for Bioterrorism Prevention, and that's Dr. D.A. Henderson, who is sitting here. Dr. Henderson, you should know as well, is one man that probably is more responsible for eradicating smallpox than any other person in America.
SHAYS: Would you raise your hand, sir?
You are the gentleman? Thank you.
HAMRE: And he is dedicating himself now to the protection of the United States against these terrible diseases.
The other is the Answer Corporation (ph), Dr. Ruth David (ph) is the president and CEO, and she was instrumental in bringing together so much of the resources -- she and her remarkable staff.
And we are ready to go.
Let me say, Dark Winter was meant to be an exercise to say, "How would the United States cope with a catastrophic event; in this case, a bioterrorism event?" We thought we were going to be spending our time with the mechanics of government. We ended up spending our time saying, "How do we save democracy in America?" because it's that serious and it's that big.
Let's go to the next chart, please.
This is what we'll cover today. We will go briefly through just to say who were the participants and the goals of the exercise. And then we, very quickly, want to take you into the exercise itself so that you have a chance to observe it. We will then pull out some of the key observations and all of my colleagues here will be speaking to those along the way.
Next chart, please.
SHAYS: Dr. Hamre, may I just interrupt to welcome Mr. Tierney?
TIERNEY: Sorry for the interruption.
SHAYS: It's great to have you here.
Would you just make your first point again about...
HAMRE: Sure. I said when -- and Mr. Tierney, we were delighted to be invited to be participants here.
We thought we were going to be getting together as a group. Everyone who was participating in this exercise were former government officials. Everybody that was sitting at the National Security Council had really been there before in one role or another. Of course, we had Governor Keating sitting as Governor Keating in the exercise. And we thought we were really getting together to talk about the mechanics of government and what we ended up doing is saying, "How do we save democracy in America if we ever have an episode like this, that were to occur for real?"
SHAYS: And I would also welcome Mr. Gilman, as well.
And I think what I'll do is since they have come before you -- jumped right in -- to give either an opportunity to have an opening statement and then we'll get right to your testimony.
Do you have any statement?
TIERNEY: I'm happy to hear the testimony.
SHAYS: OK. Mr. Gilman, do you have any statement to be made?
GILMAN: Thank you, Mr. Chairman.
I want to thank you for conducting this hearing at this time, today's hearing to examine our overall relationship between the federal and state governments.
In trying to form a cohesive and effective response to a biological weapons attack is very timely. For many years the possibility of a biological terrorist attack occurring in our own nation seemed absurd, something to be relegated to the realm of science fiction. Sadly, events over the last few years, with bombings occurring in New York and Oklahoma City, have transformed the bioterrorism debate from a question of if to the seeming inevitability of when.
The task of developing an adequate, effective, overall strategy to successfully counter any domestic act of biological terrorism has proven to be a difficult challenge for our federal and state policy- makers. Our nation is a highly mobile society with a system of government, where in power and responsibility are diffused between federal, state and local authorities. Moreover, the American people are accustomed to an unprecedented amount of personal freedom not found in any other nation.
All of these factors make the quick containment of any biological attack and effective subsequent quarantining of any infected individuals highly problematic. Indeed, preliminary results from the past exercises, including one recently concluded, have not been very encouraging.
I look forward to the testimony that our panelists will be presenting, and particularly those who participated in the recently held Dark Winter exercise. I'm certain that their experience and insight will prove useful to this committee as Congress works to try to find a proper role in this emerging and vexing problem.
Once again, Mr. Chairman, thank you for your leadership on this important topic.
SHAYS: Thank you both gentlemen for being here.
Dr. Hamre, let me just take care of -- a quorum is present. I ask unanimous consent that all members of the subcommittee be permitted to place an opening statement in the record. And without objection, so ordered. I also ask further unanimous consent that all witnesses be permitted to include their written statements in the record. Without objection, so ordered. And three days for both.
You now truly have the floor. Do you want us to dim the lights a bit? I'm afraid to ask. I don't know if we know how to do that.
HAMRE: I'll leave it up to your professional staff that has a better feel. I think we can see it and I think if it's all right, it will be all right.
SHAYS: OK. We'll leave them on.
HAMRE: I forgot to mention that this exercise, because all of us are not-for-profit entities, was funded by two entities. It's very important for me to say this. This was not paid for by a contractor, this was not paid for by the government. This was paid for by two not-for-profit entities that are dedicating themselves to helping protect America: the McCormick Tribune Foundation and the Memorial Institute for the Prevention of Terrorism in Oklahoma City.
SHAYS: Just not to confuse you, there is a screen in front of the desk, so we're now looking at Governor Keating and Senator Nunn while you're showing the presentation; is that right?
HAMRE: Yes, sir.
OK. So now we will proceed, if we could, to the next chart.
These are the participants, and I won't go through it here, every one that we had sitting there has been in the National Security Council for real.
OK. Next chart, please.
And we also, to add realism to this exercise, we actually brought in sitting journalists. They actually sat there to watch and participate because a fair amount of this exercise dealt with how would we cope with a public campaign and explain it to the American public.
Next chart, please.
These are the five goals that we had for the exercise. This is what we were trying to do. We were trying to figure out, what was going to be the impact on national security of a biological attack. We especially wanted to look at the implications for the federal and state interaction. And this turned out to be one of the most important elements for us to learn, and we will bring some of this out in the lessons learned later on. But I must tell you there was a major divide in this National Security Council between those who were at the national level and those who understood the response at the state level, and we should talk about that later.
We were specifically looking at, what does it take to make these life-or-death decisions when we don't have enough money for what it really takes to do it, and coping with a scarcity of assets and especially vaccines was a major dimension to the exercise. We tried to deal with the issue of information; how do you communicate to the American public at a time of extreme crisis? And then, finally, to talk about the very tough ethical and moral issues that came from this exercise.
Let's go to the next chart and I think it's going to get you to the beginning of this as the way we experienced it.
(UNKNOWN): Good evening. We interrupt our regular programming to return to Southwest Medical Center, the continuing coverage of the outbreak of a mystery sickness. Earlier today hospital officials said they were admitting patients with symptoms that seem to be severe adult chicken pox. But now we have new information. We go to Andy Field outside Southwest Medical Center.
Good evening, Andy. What can you tell us?
FIELD: Sheila, we've been moved to an isolated area behind the hospital and, off the record, doctors here suspect that at least five patients hospitalized at Southwest may have smallpox. And for those of us who don't remember the disease, it is a deadly virus. We haven't seen it in this country in at least 20 years.
Now, if this proves to be true, we could have a very serious health emergency on our hands. But, officially, the hospital will not confirm or deny that diagnosis.
HAMRE: So when the National Security Council met this evening, the first night of our exercise, they thought they were getting together to talk about a crisis that was emerging between the United States and Iraq. Because we'd learned of this breaking news of a potential smallpox attack, the president called the National Security Council together. Fortunately, Governor Keating, who was in town anyway, joined us for the exercise and, of course, we're explaining his presence. He'd normally not be at an NSC meeting, but he was there that evening.
Let's go to the next chart, please.
This is what happened on the first day. This is what the NSC was learning that night. But what we are looking at is around on the 9th of December, some two dozen patients were reporting into Oklahoma City hospitals with signs of smallpox. It was quickly spreading around the town and, indeed, the Center for Disease Control quickly confirmed that it was, indeed, smallpox.
Next chart, please.
Smallpox was eradicated in the United States in 1978. We have not had any evidence of it -- or in '49 was when it was last in the United States, but it was eradicated 30 years ago. It's a very contagious disease and highly lethal; 30 percent of the people that get it will die, and once you get it, you simply have to ride it out. There is no real therapy for it. There is a vaccine that you can take, but you must get the vaccine before you've demonstrated symptoms, so it's a very tough problem to work.
Let's go to the next chart, please.
These are historical pictures of smallpox. Smallpox was the leading cause of blindness in the world before its eradication and it's a very ugly disease. This is, of course, in the more advanced stages where smallpox, after the first week or so, starts forming these poxes, and it's very ugly and it's at this stage where it's highly contagious.
Next chart, please.
The United States has approximately 12 million affective doses of vaccine that are available. It is possible to administer the vaccine but you must administer it before you demonstrate symptoms if it's going to be effective. In this case, we thought we had 12 million doses, but as you will see shortly, it's exposure in this exercise was in communities where there were more than 12 million people living. The National Security Council -- one of its initial challenges was to decide how do we administer a strategy? How do we allocate these scarce numbers of doses to the American public.
Next chart, please.
Here's what the National Security Council knew at the time. Again, I'm trying to compress into three minutes what was taking four hours in our discussion. They clearly knew that smallpox was now being reported in three states. It was reported in Oklahoma, in Atlanta and in Pennsylvania. It was presumed to be a deliberate release, because smallpox is no longer, you know, natural in the environment, and so it was probably caused, but we did not know how.
We did know that vaccination is one of the tools but the other tool is isolation, trying to prevent the spread of the disease. We also knew at the time that Iraqi forces were mobilizing. We did not know if these were related phenomena; if it was, at the same time, being connected to the deployment in the Persian Gulf. We also did not have any smoking gun; we did not know who caused it and we had no idea where it came from.
The other thing we did not know, which was very crucial, is we had no idea how extensive the attack was when it was unfolding.
So that first night, and we met on a Friday night, simulating the first day of the exercise, we were really dealing with a lot of scientific information, very little insight into what to do about it, because we did not know where it had been spread and how extensive the illness was already.
Next chart, please.
These were the key issues that we were looking at that first night. You know, who controls the release of vaccine? How do you administer vaccine? Who should be getting it? How do you protect the first responders because you need the first responders? Who's on the front line? I can remember Senator Nunn saying, "Who is the front line?" We had national security people saying, "We have to reserve doses for the military," and we had state and local responders saying, "We are the front line in this war. You know, you've got to protect us first." So it was a major debate.
HAMRE: Let's go to the next chart, please.
Now we're going to show you a video from that first evening as well.
KAVLICK (ph): And the problem is, we don't have enough vaccine to go around.
(UNKNOWN): Meaning, we don't have enough vaccine for the United States?
KAVLICK (ph): Well, I would like to think that, but we don't have sufficient stockpiles for the people in Oklahoma, Georgia or Pennsylvania, much less for the entire United States population.
(UNKNOWN): Well, that certainly doesn't sound encouraging. What do you mean exactly?
KAVLICK (ph): Angie, it means it could be a very dark winter for America.
(UNKNOWN): Sobering. Thank you very much for joining us, Dr. Kavlick (ph).
We do continue to wait for official reaction to this developing situation. Now we go to a special report on the deadly affects of smallpox that lead scientists to launch an eradication program thought to wipe out...
HAMRE: Through the exercise, we were introducing videos along the way to give some sense of realism to the evening.
OK. Let's go to the next chart, if we could.
Here's what the council decided on the first night. They decided to try to accelerate the production of vaccines. There is ongoing production, but emergency production would be required and you would need to waive a fair amount of regulation. If this happened tomorrow, we would have to waive a fair amount of federal regulation in order to get vaccines available on an expedited basis, and that even meant six to eight weeks before we could get them.
We asked the secretary of state to look for vaccines in other countries. It turns out Russia had stocks but there was a question about the safety and effectiveness of those stocks, and so that was an issue that the council had to deal with.
The National Security Council ordered a ring strategy; try to find people that have been affected and then inoculate the people that are in, as it were, a circle of acquaintances around the individual who had been infected. One of the classic strategies for dealing with a contagious disease.
Also, they directed that stock to be reserved for first responders, because if you're expecting to see health delivery and security in infected areas, you have to reassure the people that have to provide that security with a vaccine or else they probably aren't going to do it and you wouldn't expect them to. And, finally, they did reserve stocks for emergency breakouts if there were any further breakouts to occur.
Now, let's go to the next chart.
Here is what was not understood at the time of that first evening, is that the participants really never could see the full scope of the initial attack because they didn't know the facts yet. They weren't yet in. That, indeed, the infection rate was showing up first in the cities where it was released and they were released in three locations; a deliberate attack in Oklahoma where it was successful, and two botched attacks; one in Atlanta and one in Philadelphia. The participants did not know that at the time of the first evening.
And so this was the scope of the infection that was not even understood when people were having to make initial decisions and this would be very typical of a bioterrorism incident.
Next chart, please?
The priority was given, you know, for vaccinations and isolation. The stocks were very inadequate, given the scope of the initial attack. We, again, didn't realize that until the next day, but it was one of those things that was unavoidable.
And very difficult to get situational awareness; to know what's really going on. If there were one or two people that showed up in another state, was that another source of an attack or is that just the pattern of people's normal commerce? Remember, this occurred -- in the scenario, it occurred at the start of the shopping season before the Christmas holidays, and it occurred in a shopping center and that's why you don't know if it was a single point event or if it was widespread.
NUNN: Let me just add a point of emphasis there. If we had known for certain or even speculated with some reasonable basis that there was a certain area we could have isolated it, obviously, whatever you needed to do should have been done right at the beginning; isolating Oklahoma City, isolating parts of Georgia, whatever.
But there was no clarity. We kept asking, "Do we know that it hasn't already spread all over?" And the answer was, "It could have spread everywhere," because we didn't know for 10 or 12 days that it had even happened and those people that were in those shopping centers had dispersed in all directions.
So when you start basically impinging on the civil liberties and telling people they forcefully have to be kept in their homes that may have been exposed, and when you call out the National Guard to do that, and you, at gun point, put your own citizens under, in effect, house arrest, and you don't even know that you're catching the right spot or that you're dealing with the right people, that's a terrible dilemma. Because you know that your vaccine's going to give out and you know the only other strategy is isolation, but you don't know who to isolate and that's the horror of this situation.
I just wanted to emphasize that as a point of emphasis.
GILMAN: Mr. Chairman, would you yield a moment?
How do you learn the extent of that kind of an outbreak? I address that to Senator Nunn.
NUNN: I think that Dr. Hamburg would probably be the best one to answer that. I think the answer that night in our exercise was we really could not.
HAMBURG: We immediately would begin, as you identify cases, to put together the pieces that are common in the recent experience of the individuals who are sick and begin to do an outbreak investigation. We can trace back to what was the source of exposure -- the common source of exposure.
And in a case like this, although we obviously didn't have the opportunity to play all of the elements fully, that kind of outbreak investigation would have been intensively going forward, requiring a huge investment of trained personnel, epidemiologists to do that medical detective work.
At the same time, since the suspicion was so high that this was a bioterrorist event, we would also have to be having a law enforcement criminal investigation going on at the same time and trying to trace back to the site of exposure, which would also be your best chance of identifying the possible perpetrator as well.
NUNN: One other point on this, right on that point. You've got an inherent conflict between health and law enforcement. And to the extent that they haven't coordinated beforehand and don't know each other beforehand, before this occurrence took place, you would have a horror show, because law enforcement has one set of goals, health officials have another set of goals.
The president of the United States, or Governor Keating in this case of Oklahoma, and the other governors, would have to make a threshold decision which was more important. I made the decision it was health rather than law enforcement. But that drives an awful lot of decisions. And If you don't have any advance coordination between health and law enforcement, you got a huge problem. And the same thing would be the case of health and National Guard or health in the military. And the same thing between the whole federal, state and local governments. So that is a real dilemma.
GILMAN: Thank you, Mr. Chairman.
SHAYS: Thank you.
HAMRE: Let's go to the next chart.
(UNKNOWN): On day six of the smallpox epidemic, the White House confirmed that federal government officials and military personnel are being vaccinated. Three hundred people have died; at least 2,000 are infected with smallpox. Smallpox symptoms are being seen in 15 states, also in Canada, Mexico and England.
The U.S. smallpox vaccine supply continues to shrink as officials try to stretch limited stocks to cover the entire nation. An official announcement regarding the remaining vaccine inventory is expected later today. Struggles to get vaccinated led to violence in some cities.
Profound economic losses are crippling the nation. In Oklahoma alone, economic experts project severe losses in the state's multi- billion-dollar agricultural commodities market.
Still, no group claims responsibility for unleashing the deadly smallpox virus. But NCN has learned that Iraq may have provided the technology behind the attack to terrorist groups based in Afghanistan.
HAMRE: Let me again, Mr. Chairman, say that this was a simulation. For people that may just be joining us, please, this was not real, but this was something that we were simulating in an exercise.
SHAYS: Still chilling.
HAMRE: Here is what, again, the National Security Council knew. This was the beginning of the next morning. Basically we advanced the clock, we were now at the sixth day in the exercise. Here is what the National Security Council was confronting: that they had over 2,000 people that had been infected; the medical care system had been overwhelmed.
You know, we have cut back medical care so that it's to the least amount of excess capacity in peacetime as possible because we can't afford it. And, of course, when you have a catastrophic event like this it overwhelms the medical care system very quickly.
For all practical purposes, the vaccine is now gone. Because you're trying to contain it in each location, it's now at over 20 states, we're out of vaccine.
Still, the council does not know where it came from or how widespread it is. It's clear that it was probably deliberate, but it's unclear if this was terrorism or was it really an act of war.
Let's go to the next chart, please.
(UNKNOWN): We have a breaking story from Oklahoma. We go straight to Andy Field of Oklahoma City's KMSA.
Andy, are you there?
FIELD: Angie, Texas Governor Rick Parsons has now suspended all surface and air contact between Texas and Oklahoma. He has ordered his state troopers and the National Guard to seal the borders.
Now, we're about a mile away from the Texas border here, just near Interstate 35 and the Red River Bridge that connects the two states. The troopers here have taken the media to what they call a so-called safe spot, but as we've told you earlier today, Oklahomans by the carload have been seen leaving the state in every direction trying to escape this deadly smallpox outbreak. And we have reports of vigilantes at the Texas border trying to stop people from coming over.
I don't know if you just heard that. That was a shot fired. We've heard -- there's another one. Now, we're not sure where these shots are coming from, we're a little too far away from the border to hear this here, but there have been shots. This is the second time in the hour we've heard this. The National Guard and the Oklahoma state troopers are here with us. We're not certain who's doing the firing or if what we're hearing is returned firing.
There's another shot. This is starting to sound like a war zone.
I'm Andy Field reporting.
HAMRE: Next chart please.
Let me emphasize that this was not a game where there was a right answer or a wrong answer. I mean, this was a case where none of us were experiencing anything we'd ever lived through before. And so the National Security Council was coping with very stressful situations, so please don't judge them as to the decisions that they made. There is no right answer here, we're all learning.
At the time, the participants came to realize that now vaccine was no longer going to be an effective solution. We were out of it. And we now had to deal with issues of how do you constrain it by constraining people's movement and behavior.
There was a major debate inside the National Security Council at the time between the national security side and the local response side as to whether or not we should federalize the National Guard.
Let me ask Governor Keating to jump in and speak just to the issue from a governor who's sitting there, what he was confronting when we had this debate in Washington over whether we should federalize the Guard.
KEATING: Well, I certainly wasn't very happy about what those pesky Texans did to my border.
But the problem, as Senator Nunn said, was the level of information that we had and the expectation of a local decision-making and local response.
I might say that the one thing that we didn't have, because that's the nature of the beast, was information. The first question that was asked by us was, "What is smallpox? And what is the cure? And are there vaccines? And what do we do?"
Well, for me as a governor hearing this information, suggested by the president that we encourage people to remain in their homes, that we encourage little, if any, transit between population centers, I made a decision to close the airports, except for supplies of medical equipment and personnel; also the roads, except for supplies of medical equipment, personnel and food and other essential items, provided the truckers are vaccinated. And that was an ad hoc decision on my part.
One of the generals at the table -- and this is why there was no script whatsoever, Mr. Chairman, except the first comment that was made right at the outset, somebody said, "What authority do you have to do that?" And I said, "Because I'm the governor of my state. I'm going to do it because this is how I think I should respond to a calamity such as this."
The most important thing that we needed was information, and obviously once that information was imparted, provided it is able to be relied upon and it is firm and final, then suggestions from the federal family as to what assets and resources would be available. In our federal system, with such diffused decision-making, that's crucial. What are the facts? What's the answer? What are the resources that should, must be made available to address it? And, obviously, the comity, the information that should, must exist between the federal family and the state and local family was essential.
I was basically the skunk at the garden party. I raised the issues of the need for a bottom-up response as oppose to a top-down response, and sometimes I won, sometimes I lost. But the president did an outstanding job of making sure that I won as many times as I lost.
NUNN: One added footnote on the governor's comment: We were told the Texas governor had nationalized the Texas Guard and blocked the border with Oklahoma. Well, obviously, if other states around Oklahoma had done the same thing, they would have been isolated. You couldn't have gotten food, water, whatever they might have needed in emergencies in there. So it had the possible result of being absolute, total disaster.
All of my national security advisers, the secretary of defense, the whole team of national security advisers sitting around the table advised me as president to nationalize the Texas Guard, thereby overruling the Texas governor. That was a hard decision, but I decided not to do it. I decided to get the governor, who happened to be there, but in case if he hadn't been there I would have gotten someone else or I might have called myself to try to plead with the Texas governor not to do that, not to have that kind of force.
But I judged that I tried to nationalize a Guard force that had been mobilized by their governor to protect the citizens of their state in their eyes, and to protect their own families, the worst of all worlds might be that they basically wouldn't respond to federal authority, and then you would have had pure anarchy. And I felt that the threshold decision had to be made that this had to be a partnership and we had to go to every length to try to convince the governor of Texas to cooperate.
So that was the way that one was playing out. And, of course, Governor Keating, I kept sending him out of the room to go talk to the governor of Texas during this whole time. So that probably wasn't exactly realistic. But I would have been, had he not been there, on the phone with the governor of Texas myself.
KEATING: Well, and let me postscript what Senator Nunn said. The challenge for me, having had survived both a natural as well as a man-made tragedy in my state, was to convince the federal family around that table that the best response was, in fact, the local response; that the local people trusted the police chief and the fire chief and the health officials locally, they didn't know who these federal people were.
KEATING: What we needed from the federal government, from FEMA particularly, were the assets and the assistance and, as Dr. Hamburg noticed, the facts to permit us to respond in an intelligent and in a factual way.
I got into somewhat a friendly but firm dialogue with the military whose initial response was, "Find out who did it and bomb them." Well, I don't have a problem with responding forcefully as an American -- anybody who would do this to our states or our country. But our challenge, and that's why I commend Senator Nunn as president and his challenge, which he accepted, was to focus on rescue and recovery and medical care and quarantine and isolation and the health side, and we will take care of the bad guys later. And I think that's something that obviously leadership alone will make that decision. That will not happen by accident. And in his case, he responded appropriately.
NUNN: I do believe there are a lot of lessons to be learned and I'll just inject one here on this point. But it was apparent to me that we needed a large group of nurses and doctors and we needed to bring them in from all over the country, and indeed perhaps all over the world. And the only way you could do that is probably advanced planning.
Also, the question in my mind -- I'm not up-to-date on everything the National Guard is doing in this area, but it was also apparent to me, and the more I've thought about it afterwards, the more apparent it has become, that our National Guard forces need to be able to mobilize all the Reserve medical doctors that they can possibly get, whether it's Guard doctors or Reserve doctors, and even active duty officers who have medical knowledge. And we need to have some advanced planning on that.
It wouldn't just be the Guard forces with their guns and with their ability to protect property and so forth, we'd need. We'd need all the medical expertise we could possibly muster.
And the public health system and the Public Health Service would have to be at the heart of that. And I believe you said that in the beginning, Mr. Chairman. I want to strongly underscore your point, because I believe that we really need to pay a lot more attention to our public health system.
And that's the case even if we don't have a terrorist outbreak. That's the case with just natural infectious disease.
KEATING: And as a response to that need for a coordinated mechanism, it was for me, representing the state and local authorities to say, "Don't forget the National Guard best responds to local oversight control. Don't forget the Salvation Army. Don't forget the local health officials. Don't forget the American Red Cross. Don't forget the churches and the social service agencies below." They can be -- must be coordinated into this health care response as well. You can't have any success unless they are integrated fully into it.
NUNN: But one final point, we'll get back to the scenario. Every one of those people you're trying to mobilize is going to have to be vaccinated. You can't ask them to go in there and expose themselves and their family to smallpox or any other deadly disease without vaccination. So that's the front line, that's the front line more than any pure military force. You've got to vaccinate them and you've got to have that right at the beginning. And that kind of supply needs to be set aside.
HAMRE: Mr. Chairman, we are now at the end of the sixth day. And so, let me now go to the next chart as we address...
(UNKNOWN): No other country in the world is accepting flights originating in or transiting the U.S.
On day 12 of the worse public health crisis in America's history, demonstrations for more vaccine in hard-hit communities disintegrated into riots and looting around the nation. Interstate commerce has stopped in several regions of the nation. A national suspension of trading on America's stock exchanges takes effect tomorrow. International commerce with the U.S. has virtually ceased.
The Centers for Disease Control report that efforts to stem the smallpox epidemic have depleted America's inventory of smallpox vaccine. While the CDC may be out of the vaccine, at least 45 Internet web sites are now offering what they claim are safe, effective vaccines. These claims have not -- we repeat: They have not been independently verified. Authorities urge caution.
At least 25 states and 10 foreign countries are reporting smallpox infections. At the United Nations, temporarily meeting in Geneva, China has sponsored a resolution to censure the U.S., blaming America for reintroducing smallpox to the world. It demands the U.S. supply the world with vaccine.
Since the diagnosis of 20 smallpox cases in Oklahoma City 12 days ago, hundreds have now died, thousands have become infected. The latest figures show more than 15,000 new cases in the past week. Officials now question whether a single attack could be responsible for this outbreak pattern developing in the U.S. But they project that each two- to three-week period will see a minimum tenfold increase in new cases.
HAMRE: Next chart, please.
This is the beginning now of the third phase face of our exercise that was on the 12th day of the scenario. The most important thing is the second bullet. Remember small pox is so dangerous because it's communicable. And every one person who gets it probably is going to infect 10 more. And now is the first time we're starting to see the second wave of infections, that is the infections of people that come in that caught it from people who were exposed in the very first hours.
As you can see in the last 48 hours there were 14,000 cases. We now have over 1,000 dead, another 5,000 we expect to be dead within weeks. There are 200 people who died from the vaccination, because there's a small percentage and we've administered 12 million doses, but now we've had 200 that died from the vaccine. And at this stage, the medical system is overwhelmed completely.
Next chart, please.
This was what the members of the National Security Council saw. They saw this spread. You see the three red zones. Those were where the initial attacks took place, in Oklahoma, in Atlanta and in Pennsylvania. The only Oklahoma attack was successful, but as you can see it spreads wildly anyway.
Next chart, please.
These are the cumulative -- the results of the cumulative compounding of the people that have been infected. You see the cases per day and you see it's starting to rise at day 18 and starting to go up sharply. That's the second wave of infections, people that are catching it from the people who were first infected.
Next chart, please.
And this, unfortunately, was what the National Security Council was looking at. For people that may not be able to see that in the back of the room, at the end of the first generation of infections, approximately the 17th of December, there were 3,000 infected and there were 1,000 expected to be dead. At the end of the second generation, what we were now looking at, it would be 30,000 infected and 10,000 dead. We were forecasting within two weeks to three weeks that we would have 300,000 who would be infected and 100,000 dead. And as you can see, it goes off the charts.
It was roughly by the fourth generation that we would expect to be getting vaccine produced from the emergency production.
Next chart, please.
It was at this stage that we were confronting the reality that forcible constraint of citizens' behavior was probably going to be required to be able to stop that fourth generation of infections.
Let's go to the next chart.
We'll talk very briefly about lessons learned.
Next chart, please.
I think we felt that this would cripple the United States if it were to occur. We have a population that's no longer inoculated. For all practical purposes, 80 percent of the population has been born or is no longer affected by the vaccines when they stopped back in 1978. So the country is now vulnerable.
A local attack quickly becomes a national crisis. And we saw that very quickly, once it spread. The government response becomes very problematic when it comes to civil liberties. How do you protect democracy at the same time you're trying to save the nation?
We found that it was very hard -- we're not very well-equipped to deal with the consequences. I'm going to ask Jerry Hauer to comment on that when we get around to comments later on.
HAMRE: We lack the stockpiles of vaccine. I'll ask Peggy Hamburg to briefly speak to that because this is one of those key things. We have 12 million doses, but it's clear 12 million doses aren't going to be enough if we get into this kind of a crisis.
It's very likely you're going to have to forcibly change people's behavior. How? That becomes a key question.
Next chart please.
We didn't have the strategy at the table on how to deal with this, because we've never thought our way through it before, and systematically thinking out way through this kind of a crisis is now going to become a key imperative. It clearly is going to require many more exercises. The government's going to have to -- and we're very pleased that the person who, for Governor Thompson, is going to be the coordinator for bioterrorism response, Scott Lillibridge, was with us at the exercise.
And it's now very clear that public health is a national security imperative. This is not a choice. This is now an imperative.
Next chart please.
We found that state and local relations are going to be hugely strained at this time. The perception in Washington is so different from the perception in the field, and that's something that I hope Governor Keating and Senator Nunn speak to.
When I say government lacks coherent decision-making, this is not a critique of the exercise. I thought it was the finest national security discussion I'd ever seen, and I've been through about a dozen of them. It was by far and away the best I'd ever seen. But it still is very hard to cope with something you've never experienced before ever, and we're going to have to start doing exercises. Hopefully, that's as close as we'll ever get to it.
And finally, it is going to take an investment. It is going to take an investment in public health. It's going to take an investment in research and development. We've got to find some solution to this problem.
I think that concludes, Mr. Chairman. Let me turn it to my colleagues, because they have important observations, before we wrap up and turn it to you for questions.
SHAYS: Do you all -- since I've already lost control of this -- do you all have a sense of how you want to proceed?
HAMRE: I think we can just work down the table, if that's OK.
SHAYS: Senator Nunn, you look like you're ready.
KEATING: Well, he is the president, so he outranks a mere governor.
SHAYS: Mr. President, you have the floor.
NUNN: I also control the National Security Council during this whole exercise, too.
Two or three real frustrations -- one is there was no intelligence. Couldn't find any intelligence. We had no way to link these attacks with any foreign country. You know, your urge is to retaliate, but you have no idea who to retaliate against. That's the point Governor Keating made.
Second, you really know from the beginning when you first hear about smallpox, the credibility of the United States government is absolutely essential. And yet when you're faced with your first news conference and you turn to your colleagues around the table, and, "Give me the information base, give me the basis on which I'm going to speak to the American people," you know you need to be candid. You know that you need to be reasonably accurate. You know you need not to be reversed from what you said in three days. You have no information base. And yet you've got to reassure people and you've got to calm them down. That was one of the most frustrating things.
And from that came the acute awareness that dealing with the media in one of these -- if it becomes a reality, one of these real terrorist attacks, or outbreak of infectious disease which got out of control -- dealing with the United States news media would be absolutely essential. They would have to be partners, because if you lost credibility and they basically started attacking the government, you'd have nothing but chaos.
And so you certainly couldn't co-opt the media. And that means you've got to have a lot of advance preparation and you've got to know what you're talking about and you've got to have the best spokespeople you could possibly have at the federal, state and local level. And there has to be some coordination in advance.
I think your most credible people would be your health officials, and I believe that the more I thought about this afterwards, the more essential it became in my own mind to have a whole group of health officials at every level who worked together and who could speak to this subject with credibility. Because I think if you tried to get law enforcement people out there talking about apprehending someone when people are faced with smallpox right next door, they'd really say, "That's not what I'm worried about. I'm worried about my family, my children."
So those are a few things, but we really need to be prepared. The government's not organized for this. We need to be structured for it. We need to think about it in advance. We need to do the best we can in terms of detection. I think we need a global health system that can detect at an early stage any infectious disease, because in the period of globalization, when people are moving all over the world, if we don't have that early warning from whether it's Africa or Asia, or whether it's Oklahoma City to the world, then we're not going to be able to get in front of this kind of episode.
We need a whole lot more vaccine. We need to have an analysis from our people in the government of what the threats really are, and which threats are greatest. You can't prepare for every threat, but we have to have an array of threats as to which threat is greatest in terms of biological. And then we have to weigh chemical and we have to weigh nuclear. We have to weigh missile defense. We have to weigh all those threats in an analytical way. And I don't think we've done that yet.
Because there's going to have to be some real money spent here, if we're going to get a public health system. The market forces -- and this is the other thing the governor and I were talking about earlier, the market forces in this country for health care are striving for more efficiency, and that's what Congress has really tried to set up, and rightly so.
But the more efficient you get, the less excess capacity you have. And when you get one of these outbreaks or an infectious disease outbreak, you've got to have excess capacity. And you've got to have vaccine that may never be used. The marketplace is not going to provide that. The marketplace simply can't provide it. You can't ask the pharmaceutical company to go out and, for free, develop smallpox vaccine by the millions of doses when the likelihood of it happening is certainly not very great. And yet if you're not prepared, you're in real bad shape.
So it's clearly a governmental area, and I think we need to use market forces wherever we can, but there are a lot of areas here that are going to work against efficiency, but toward the protection of public health.
Most of all, I would underscore preparing and paying real attention to the public health system of the country.
SHAYS: Mr. President, who do you want to recognize next?
NUNN: Well, during our scenario, the governor never needed to be recognized; he really just was very assertive the whole time. And we really did enjoy having him there. I'm not sure I would advise any president to have a governor in the room, because they find out how ill-prepared we are up here.
KEATING: But I was respectful, Mr. Chairman.
SHAYS: I'm sure you were.
KEATING: I think the natural result of this should be a debate, a discussion of how to respond to both man-made and natural disasters. What is the likely natural or man-made disaster that you will confront? Those of us in the middle of the country anticipate tornadoes; on the coast, hurricanes, obviously earthquakes. Every fire department, police department, civil emergency management agency worth its salt has murder-boarded the issue of response to a natural calamity that happened and frequently happened on more than several occasions.
You know when something like that happens, you need so many hospital beds. You need so much water. You need so much extra power. You need such quantity of medical supplies. And you have murder- boarded it. You have debated it. You have discussed it with your National Guard commander, with the civil emergency management people, the head of which every state has, to anticipate and respond.
This is the kind of thing that the individual states are not in a position to anticipate and respond, because they have no knowledge. What stunned me -- and Dr. Hamburg during the scenario made a very excellent statement to the effect that many medical doctors, health care professionals, because smallpox has been eradicated from the United States and from the world for several generations, that there is no knowledge, no experience.
So when something like this happens, as Senator Nunn said, to have health care professionals probably coordinated at the state department of health level, trained at the state level to recognize plague, to recognize contagious diseases, and then be able to access, perhaps through FEMA, the body of knowledge necessary to respond quickly.
I must confess that obviously I carry the torch of state and local responsibility, but I was rather surprised at the level of ignorance, if not prejudice, against state and local responders. The truth is, the first information that people receive locally about a contagious event or a terrorist act will be from the local television and radio, local media.
KEATING: It needs to be accurate to the extent that the information can be provided that it's accurate.
The initial responders always will be local police, local fire, Red Cross, the social service agencies below. They need to have accurate information. They need to be able to access -- again as I said, perhaps through FEMA, I think most respected at the state level to provide that information -- the knowledge base to respond intelligently and quickly to a calamity to make sure that there is not a greater swathe of tragedy than can be controlled.
For example, in my case, I mentioned, I closed the airports and closed the roads. All of this was spontaneous after I was told as the governor, "This is highly contagious, it is frequently fatal." Well, obviously, I don't want people coming in and then going out and infecting other areas, if this was an attack on a city in my state. Was that a right decision or a wrong decision? Well, it was made, and I could only make it based upon the information given me. The information given at the scenario, because I just happened as a friend of President Nunn to be there, was that quarantine, isolation is essential, especially because there is no treatment and because death can occur.
Well, the need to be able to have that information fully available, quickly available, accurately available; to be able to send in the medical personnel; to be able to be assured of food and water supplies and other health care essentials, particularly vaccines, these are the kinds of things that we can't produce locally -- we have to access.
Now, I think when we got into the argument over the nationalization of the Guard, I pointed out that if I had to go through 15 different people to get a decision to be made, that's not good.
On the other hand, if one person, my adjutant general, can make the decision or I can, people know me, know the governor, know the mayor, know the police chief, know the anchor on television -- the local officials with excellent information from Washington, can make wise judgments and decisions that will be embraced by the generality of the populous.
But this discussion must take place within the context of state and local first responders. They are the ones, for better for ill, that will either do it well or muck it up. And if the information provided us is inadequate or inaccurate, then the response may be quite different. And the concentric circles of tragedy may be much wider if the information early on is not accurate and fully available to those of us at the state and local level who must make the decision to respond.
SHAYS: Mr. President, who is next? Dr. Hamburg or Mr. Hauer?
HAUER: Mr. Chairman, thank you. I'll be brief, I want to emphasize a number of points that this exercise brought out. And I think you've heard some of them already. One that the country is woefully unprepared to deal with an incident of bioterrorism. More importantly, an incident of bioterrorism with a contagious agent would absolutely devastate this nation at this point in time.
Some of the issues that we had to deal with and struggle with throughout this exercise are issues that need attention. I must say that Secretary Thompson, who I've been working with for several months now, has made this a high priority and is, as part of the reorganization of the agency, in putting Scott Lillibridge in as the special assistant, is -- he wants to ensure that as we move forward we address some of the issues that came out of Dark Winter.
I think one of the things that both the governor and Senator Nunn emphasized that we had to deal with was this whole issue of augmenting medical care at the local level. It is something that would be an enormous challenge.
I think that the approach that we've taken so far as a nation is we've looked at various little stovepipes in getting the country prepared. We've gotten vaccine in place. We've put some teams around the country, the metropolitan medical strike teams. But we have not looked at a comprehensive system. An incident like this is going to take a number of things coming together or we are not going to be able to respond.
Let me give you one example. You keep hearing about vaccines. We clearly at this point in time don't have enough vaccines in the United States to deal with an incident. Having the vaccines is great, but having the ability to vaccinate people is going to be a challenge in any jurisdiction, particularly larger cities where you have to vaccinate millions of people in a very short period of time. The logistical infrastructure necessary to vaccinate the people of New York City, Los Angeles, Chicago, is just -- would be mind-boggling.
At the same time you're dealing with the logistical infrastructure necessary to deal with vaccination you've also got to augment the local medical care. Because, as Senator Nunn said, we're in an environment where hospitals are scaling down. We don't have residual medical capacity. I don't know at this point in time where we would get that augmentation of medical care. We would have to rely on DOD. We would have to rely on the national disaster medical system. But if, in fact, you had more than one state, more than one city, multiple large cities, we would rapidly exhaust that capacity very quickly.
Then, I think there's a couple of other important points and then I'll let Dr. Hamburg make her comments.
We need to address some of the issues of isolation and quarantine and the legal authorities necessary. We struggled throughout the exercise, who has the authority to do what? How do we enforce it? At what point in time do we use force on the citizens of this country? And who makes that decision?
And then, finally, I think it's very important that we look at the psychological impact of one of these incidents, and how psychologically it will impact both the people that are involved and the responders; something that I don't think we've planned for. I know that there is some work going on right now. But the psychological impact of one of these incidents would be absolutely devastating, both on the people that are impacted by the incident and those people who have to respond, just by the sheer nature of the stress of one of these incidents.
You know, back when I was a director of emergency management in New York City, my worst nightmare was one case of smallpox, not dozens. But if I had gotten a call saying that we had one case of smallpox, that would be a major, major public health incident in the city of New York. And at this point in time, as well prepared as I think we were in New York City, no city, no state is capable of dealing with an incident like this.
One final point: Smallpox is somewhat unique, because unlike anthrax where you have to disseminate the agent here, where you have to go into the subways, you have to go into an environment like a building like this and spread it, they could actually infect these people just -- you know, we have people who are suicide bombers who want to die for the cause. With smallpox, you can infect these people overseas, send them into the country. They never have to be carrying the agent with them, so there is nothing to search. And as they become infective, at somewhere between the 12th day after they've been exposed, they then start riding the subways and come into buildings like this. They might have pox on them but in the early stages it would probably not raise a lot of concern. And they could actually be the carriers, the Typhoid Mary so to speak, and spread this thing throughout the country, and we'd never know what hit us.
Thank you, Mr. Chairman.
SHAYS: Dr. Hamburg?
HAMBURG: Thank you, I'll try to be brief so we can get to your questions.
I should say at the outset that I came to this exercise and come to the discussion today with both a local and federal perspective. I served six years as New York City's health commissioner during the bombing of the World Trade Center. But also, in that capacity, clearly managed a wide range of infectious disease threats and epidemics. And also began to build a program to deal with the threat of bioterrorism.
I then spent close to four years at HHS helping to shape a still fledgling bioterrorism initiative there. And so for me, addressing these kinds of issues could not be of greater importance. And the importance of the partnership and planning that has to occur today in order to address the different levels of government and the cross- cutting nature of the response required is absolutely essential.
I think the most important point and why in some ways this exercise, I think, was somewhat unique, it really demonstrated how a bioterrorist event would be different from the other kinds of conventional terrorist attacks that we're more familiar with, sadly, or even an event using another weapon of mass destruction, that it would really unfold much more slowly over time as a disease epidemic.
HAMBURG: And that the traditional first responders, from a lights and sirens kind of response, would not be police and fire, but would be public health and the medical care system. And that we really need to make sure that we invest adequately in a robust public health system and support our medical care system so that we can provide the response that will be needed to contain and control an event like this.
That means that we really need to invest in our public health system. We need to improve our disease surveillance systems, our outbreak investigation capacity, so that we can rapidly detect an event if it occurs. Because rapid mobilization of response is what's going to be key to saving lives and containing the disease.
We have to make sure that we have a medical care capacity, as others have said, that has enough flexibility in it that we can respond. This will be key for both naturally occurring and intentionally caused events.
We do need to develop new drugs, vaccines and diagnostics to make our nation better prepared. We need to invest in research so that not only are we developing the drugs and vaccines that we know today might be effective against agents used in a potential bioterrorist event, but we have to think about new ways and new approaches that might give us greater capacity in the years to come. For example, not just thinking about one drug -- one disease, but thinking about the possibility that in the future we might see genetically engineered threats or agents that we hadn't previously dealt with, or even as we speak today there are many diseases that exist in the world, many microbial agents that threaten the human population for which we have no drugs or vaccines. So we need to really develop an appropriate research agenda; invest in that.
And I think, critically, Dark Winter underscored for all of us the importance of planning, preparing and exercising. We have a very complicated challenge before us that will require many different agencies and levels of government to come together. We cannot afford to be learning things for the first time in the midst of a crisis.
We must think about the types of challenges before us. We must think about the kinds of strategies that would be effective in addressing them and putting in place the necessary systems. And I think, as others have mentioned, the good news here is that many of those investments will have immediate payoffs in our ability as a nation to deal with naturally occurring infectious disease threats.
So we appreciate what you're doing to help make our nation stronger against the threat of infectious disease.
SHAYS: Before I recognize Mr. Gilman for the first questions, I just want to make a few observations as chairman. One is I found myself getting very uptight. And I thought, "What? Are you nervous?" I found myself just feeling very uneasy and then thinking, you know, "You can't laugh when you're talking about something so serious because, you know, that's kind of absurd."
And I was thinking that the two unrealistic things for me, the only two that I really heard were, one, that you would have been in Washington and, two, that you would have stayed in Washington, because knowing you, you would have gone back home with your constituents and your family.
But then I found myself saying, "Now, do you get the vaccine?" And if you get the vaccine, are you going to get the vaccine and not allow your wife to or any other family member? And then if you get the vaccine and then you order people that they have to stay in Oklahoma, the outcry -- they'll say, "Well, yes, easy for you to do." And just the implications on the talk shows. I mean, it was a chilling, chilling thing to see this news broadcast and knowing that that was less stated than CNN. I mean, I can imagine what some would have said and how it would have been said.
So I just find myself, in one sense, grateful as hell, frankly, that you all have been able to dramatize this. Because there have been a number of people who have been trying to say to people in the United States and to our government, "Wake up."
And not to steal something from Mr. Tierney, but to give him credit for this question. He said, "Which is more likely, an errant missile from North Korea or this kind of experience -- a terrorist attack?" Not that they're mutually exclusive, but if you told me I only had the dollars for one, there's no question I would put my dollars here.
Then just two other points. Senator Nunn, your comment about World Health Organization: I chaired the Human Resource Subcommittee of Government Reform. We oversaw HHS, FDA, CDC, VA and a whole host of others related to health care. And I am in awe of the World Health Organization. I mean, the attack I fear most is the pathogen, it's not the soldier with the weapon. And some of these individuals in the World Health Organization go around the world unarmed trying to determine what is this outbreak. And conclude by just saying to you, I have so many questions. I mean, I couldn't keep up with the questions that you all generated by your presentations.
So I know you look like you wanted to just make a point since I mentioned your comment to me. But I will call on...
NUNN: No, I'll wait.
SHAYS: OK. Well, you'll have plenty of time.
Mr. Gilman, you have the floor.
GILMAN: Thank you very much, Mr. Chairman.
It's certainly startling to hear all of these observations by this panel.
Let me ask, I think it's Mr. Hamre, you've been, sort of, the guide to putting it together. Am I right?
HAMRE: I head up one of the three organizations that cosponsored it. We did coordinate it at CSIS. Sue Rhinegold (ph), behind me, was the coordinator; Randy Larson (ph) was for Answer Corporation (ph); Tom Englesby (ph) for the Johns Hopkins Center.
GILMAN: It was Mr. Larson's (ph) idea, this initial thinking about all of this?
HAMRE: I think Colonel Larson (ph) and Sue Rhinegold (ph) together first started. But the three of them were the teammates, and Tara O'Toole (ph), who's not with us today.
GILMAN: Did any government agency participate? Any of our federal agencies participate in your Dark Winter?
HAMRE: Sir, we had observers that were at the exercise from the federal government, from various offices. As I said, Scott Lillibridge, who's going to be the special coordinator for Governor Thompson -- Secretary Thompson, he was there; very important that he could participate. We had, I think -- six congressional committees had representatives there.
GILMAN: Six of our congressional committees. Which ones?
HAMRE: Your committee was there, and we were delighted. And we had representatives from two committees in the Senate and then we had individual offices.
GILMAN: And when did you conduct your seminar?
HAMRE: We did it on the 22nd and the 23rd of June, sir.
GILMAN: In two days?
HAMRE: Yes, sir. It was on a Friday night and...
GILMAN: Well, I want to commend you all as panelists. You certainly have put together some information that we ought to make good use of.
Now, what are you going to do? You've got lessons learned and I see you have about nine recommendations. No, I'm sorry. You've got 12 significant recommendations. What are you going to do with all of these?
HAMRE: We ran out of computer disk. We would have had probably 40. But, sir, we're in the process right now of producing a report that's part of the grant that we were given by the McCormick Tribune Foundation and by the Memorial Institute for the Prevention of Terrorism.
GILMAN: What are you going to do with that report?
HAMRE: And that is going to be circulated and made available to the Congress and to the executive branch. It really highlights the things that have to be done. We've signaled some of them here.
The most important thing is that the government needs to start exercising itself. It needs to start going through this kind of a process to figure out what would we do when we're confronted with this sort of a dilemma.
GILMAN: Well, where would you focus that attention? Who should be the implementer now of all of this? Should there be a central office, for example, to implement your recommendations?
HAMRE: Sir, I think that President Bush had decided that he's going to put the focal point with FEMA and the director of FEMA is going to be taking the lead. The vice president's office is coordinating an interagency review process right now.
GILMAN: Of this report?
HAMRE: No, sir, of the issues in general. And we will be sharing it with the director -- with FEMA's director, Mr. Lacy Suiter. We'll be getting together with him later this week and I'm meeting tomorrow with the vice president's chief of staff.
GILMAN: Now, what would your panel feel is the appropriate central authority for instituting your comprehensive plan?
HAMRE: Well, I will let others speak. But, sir, I think President Bush needs to decide how he wants to organize his government. I think he's decided that. I think he wants to put the focal point on FEMA and then have the vice president be the coordinator of the interagency review that's required to support that. So I feel that's decision has been made. I think we ought to be doing what we can to help him make that decision work.
GILMAN: All right.
Well, let me ask our other panelists. What do you recommend for the proper and effective implementation of your findings?
KEATING: Well, let me analogize, if I may, Mr. Gilman, to the Oklahoma City bombing. We had a criminal investigation going on simultaneously with a rescue and recovery operation. It would be a similar event if this were to occur: a criminal investigation in companionship with a rescue and recovery and health care response. Obviously, local police and the FBI would be in charge of the criminal investigation, but they are not health care providers, and the rescue and recovery people, the local civil emergency management people, are not criminal investigators.
The resources that are needed for the purpose of responding to the health care challenge -- not the criminal investigation; those resources are already fully available in the FBI -- have to be directed through an entity that state and local governments trust and frequently work with. In my judgment, that is FEMA.
During the tornadoes that we had two years ago, the most severe ever to strike the United States and, of course, the Oklahoma City tragedy of April 19, 1995, under then Director James Lee Witt, the resources that were provided were provided promptly and fully -- the advice, the counsel promptly and fully in companionship with state and local authorities. It's a mistake to have someone say, "I'm in charge here." There has to be a sense of comity and goodwill and joint sharing of responsibility, and that can be, is done all over America all the time.
In this kind of situation you need the medical and the health care fast. And in my judgment, only FEMA should be able to provide because we work with FEMA always.
GILMAN: FEMA then is the appropriate agency...
KEATING: In my judgment, yes, Mr. Gilman.
GILMAN: Senator Nunn?
NUNN: I think the governor's last point is what I'd like to underscore. This cuts across agency lines. I've heard John Hamre say a number of times, the government's involved and structured as stovepipes, and yet, vertically. But the problem here is horizontal, so it goes across a lot of different agencies.
I commend Secretary Thompson for stepping out and having real emphasis on this, as we heard from Jerry Hauer. I also believe that someone at the National Security Council is going to have to have this portfolio. And I would have someone have this portfolio who's not spread too thin, so that they can look across governmental agencies. I think the state's federal has got to be given a lot of attention from the National Security Council and the HHS point of view.
I believe it's essential that HHS officials be able to coordinate and have the president's blessing in advance, made clear to the other Cabinet officials with the Department of Defense, with the CIA. I've been told that some HHS officials in key spots that deal with this overall subject that don't have clearances. We're going to have to have coordination between health and security. I believe that is one of the fundamental underlying principles here is, health is security, and an attack on the public health in this country is a security threat and we have to join those.
So I think that's the way I would approach it.
GILMAN: Well, Senator, if I might interrupt. Then are you disagreeing that FEMA should have the ultimate authority?
NUNN: I think FEMA is going to play a big role. But FEMA does not have the health, kind of, capability that they're going to need. They're going to have to go into the local communities and deal with doctors and they're going to have to do it up here in Washington.
GILMAN: What I'm seeking is, who should have the primary authority here?
KEATING: Mr. Gilman, let me postscript what I said. And I'm afraid I didn't fully develop my thought.
What happens here is very relevant to what happens in Philadelphia or Atlanta or Oklahoma City. The coordinating mechanism here -- for example, as Senator Nunn has indicated, if within the National Security Council there's a portfolio for this, if there is a coordinated group put together in Washington under the vice president's direction or under the FEMA director's direction does matter, as long as HHS, everybody around the table -- Department of Defense -- developing the book. How do you respond to this -- smallpox or a hurricane or a tornado? Then you take the book and you give it to FEMA to share it with state and local officials who will have to implement the results of the book.
What I'm saying is, to have a whole panoply of federal agencies descending on a city won't work, because the local health commissioner, the local mayor, the local police chief, the local National Guard commander, those are the ones that will actually implement the book, the reaction to whatever this tragedy may be. How it's coordinated here is not as important as having some kind of product that is shared with FEMA that we deal with daily in response to man-made and natural calamities.
GILMAN: Well, Governor, that's why we recommend a specific agency or specific comprehensive coordinator. We just went through a hearing on fragmentation by so many agencies, proper supplies for our defense forces. We found it's fragmented through a number of agencies and it was really no central controller. And that's why I'm seeking that appropriate...
NUNN: Well, the key here is it's got to come under the president. He's got to direct it. Because unless his authority is behind it, my experience is you can pass a piece of legislation and say somebody's czar of something, and yet if the czar doesn't have any troops out there, and if he doesn't have an agency, and if he doesn't have a large budget, and if he doesn't have power in the bureaucracy, nothing happens.
I remember when we appointed a drug czar, Mr. Chairman, many years ago.
GILMAN: We worked together on that.
NUNN: Yes, we did, and I supported that. But after you've been in office about a year, a year and a half, he came to see me and I was shocked to find what he wanted me to do was get him an appointment with people at the Department of Defense. He hadn't been able to get an appointment at that stage.
But we had the drug czar up here, and yet, he didn't have anybody under him. He didn't have any power. He didn't have any huge budget.
GILMAN: We finally got him into the Cabinet.
I only have a moment or two left.
HAMBURG: Well, quickly, I think that it is key that we have a national plan and one that involves a true cross-cutting approach. Preferably, I think, and it's my personal opinion, there needs to be some mechanism of coordination that's central that has real accountability for both program and to some degree budget, so that we really know across this wide array of agencies what...
GILMAN: I think we recognized that. What I'm looking for is do you folks have some specific recommendation of who could do that most effectively?
HAMBURG: Well, your question, in a way, was who on the ground should be the lead also, though, right?
GILMAN: Well, who nationally should take control of all of this?
HAMBURG: You know, I think it actually could be a number of different players, but the key is that it be clearly defined and that we build around that. I think, as Dr. Hamre said, the president has made the decision that it should be FEMA, and I think operating on that assumption that there are very natural partnerships that can then unfold. We want to build systems to respond to this threat that complement the kinds of activities that we do every day, either in public health, disease control, or in emergency response, so that we're not creating new systems in crisis.
GILMAN: Thank you. I'm exceeding my time and the chairman's getting a little rancy on this gavel.
Mr. Hauer, would you just answer...
HAUER: Yes, very simply, FEMA needs to be the over-arching agency that does the coordination of this at the federal level. And then rely on agencies like HHS for the expertise to deal with the unique parts of the bioterrorists.
GILMAN: Thank you very much.
Thank you, Mr. Chairman.
SHAYS: I thank the gentleman.
Just another observation, I felt like I've been in the middle of a movie and maybe that's why I was anxious; I wanted to know how to it turned out. And so I asked my staff, "How did we finally get a handle on it?" You know, 12 million vaccines out, you know the disease spreading. And the response to it was, "We did not get a handle it. They stopped the exercise before resolution." Kind of scary.
NUNN: We were faced a dilemma right at the end of having received, very graciously, from Russia, a very large supply of vaccines, and we were then trying to decide whether to use them, and, of course, one of my national security people popped up and said, "What if it's sabotage? Can we test them?" And we were still waiting on the other emergency vaccines to come in, and we were in panic as you saw on television.
So we can't contend that we solved this problem. But I do think that no policy person, Congress or the White House, could sit through this and not say, "We better get off the dime; we better do something about it."
There's one other thought I'd like to inject, that I don't think has been covered. We basically need to have the people who deal in biology understand the sensitivity of the materials they're dealing with, if they got in the wrong hands. There needs to be an ethical best practices safeguarding system in this country to begin with, but throughout the world, in dealing with these material, most of which are legal and legitimate. It's not like nuclear materials, which are, hopefully safeguarded and kept in certain spots, and we're trying to work on that in the Soviet Union. But the biological materials are part of our everyday commerce.
SHAYS: Thank you.
Mr. Tierney, you have the floor as long as you want it.
TIERNEY: Dangerous thing for you to say.
SHAYS: Give or take.
TIERNEY: Thank you.
Thank you all, for your testimony and for going through that exercise. I didn't make an opening statement, so I'm going to take the liberty of just making at least an opening comment here.
Senator, you talked very briefly about prioritizing the threats on this country, and I couldn't agree with you more. I'd be remiss for my own personal reasons, for not just saying here that I think it's abominable that we're spending so much time on reinventing Star Wars and all of this other silliness that's going on here without attending to the real prioritization of what real threats are, and making a determination as to what really needs our attention first, and how deeply that attention is needed.
I know also that this administration just pulled out of the protocol for the biological weapons convention, so that at least in the short term we won't be getting any real notice of any situation like this nor the opportunity to inspect or to move in that direction -- both of which I find a little disturbing.
Let me ask -- I would assume, Mr. Hauer, that we don't have the hospital capacity right now, if we were to get involved in an incident like this with all the hospitals downsizing. I would assume that if we're really going to be ready for this type of an incident, we would be trying to think of some system -- statewide at least, Governor, if not nationally -- to determine how many hospitals we ought to have, where they ought to be placed for ready access to the people.
HAUER: You're absolutely right. I think, though, it's unrealistic to think that hospitals are going to develop a surplus capacity, and just have it on stand-by for an incident like this, just because of the cost.
I think the issue at this point in time, is trying to figure out how, when we have an incident like this, whether it's anthrax, smallpox or some other agent, we can rapidly increase capacity, both in existing facilities, by augmenting staff and then finding alternate care facilities or casualty collection points where we can triage people who are sick with either smallpox, or anthrax or something along those lines, and we take them and put them in a facility, and we augment the local medical care, either with state resources or more than likely, particularly with a contagious agent like smallpox, we'll have to augment that with federal medical assets.
TIERNEY: Thank you.
For anybody who wants to answer this question, I assume that there was some determination made, or at least some thought given to the fact of whether or not we would want to have enough vaccine for foreseeable types of incidents for our population, or was it that we were thinking of having an infrastructure in place that could readily produce the kinds of vaccines and antibiotics that we would need?
HAMBURG: Well, with respect to the smallpox situation, there was a remaining stockpile from the days when we actually were addressing smallpox as a disease. Smallpox vaccine, luckily, is fairly durable.
There was a decision made a few years ago that we needed more smallpox vaccine as a nation to protect against this potential threat. Obviously, it remains a low probability threat, but very high consequences, as Dark Winter I think so compelling illustrated.
And so the Department of Health and Human Services does now have a contract with a private manufacturer to produce 40 million new doses of smallpox vaccine. That is a research and development task, though, and the current plan, which is somewhat accelerated compared to some vaccine development, is that those doses would be available in 2005.
In the exercise, we simulated the possibility that we might try to mobilize those more quickly. At a stage that we're at now, one could produce millions of vaccine doses potentially, but it would be untested vaccine, which, of course, raises a whole set of other issues in terms of what does it mean in an emergency to use drugs or vaccines that haven't yet been licensed. And we made the decision early on that, given the gravity of the situation, we would certainly move forward.
But smallpox vaccine is one critical need that I think as a nation we need to continue to address and make sure that we do develop that additional vaccine supply. And I think that we need to make sure that we think about the investment in developing new smallpox vaccine and other vaccines against the bioterrorist threat as a security concern, and make sure that we're not taking dollars from other existing medical problems to support that vaccine development, but that we see it as part of our national security investment.
TIERNEY: Well, just for the additional doses of this smallpox vaccine you're talking about is about $350 million. And that is for smallpox, but I guess I'd like to also ask you, do we look at the other anticipated things that might happen -- anthrax or whatever -- and also decide what a fair amount is the set-aside on those?
HAMBURG: Absolutely. I think that we need to really step back. And I wanted to make the comment earlier that in addition to thinking about what do we need to do in order to improve on-the-ground response, we also need to ask the bigger question of what do we need to do to improve overall preparedness. And part of that is really defining the set of threats as we see them today, and looking at what do we have to respond to them and making sure that we develop new drugs, vaccines and diagnostics for rapid detection -- to address those.
And that we also think into the future about what may we need, given what we know about the new understandings of biotechnology capacity, the revolution in genomics, et cetera. We can't just assume that the diseases we know today are the threats of the future. So we, I think, really do need to think very carefully about developing a research and development agenda. And there is no doubt, as Senator Nunn indicated earlier, that we cannot rely on the marketplace to serve our country's needs in terms of some of the new pharmaceutical tools that we really will require to be truly prepared.
TIERNEY: What's the shelf-life of these things? If you make that vaccine, how long is it going to be good for?
HAMBURG: Well, it depends on the particular vaccine. The smallpox vaccine stockpile that we have today is really very old. In the best of all possible worlds, I think we wouldn't choose to keep vaccine on the shelf that long. But it's tested periodically and it has been determined and FDA-approved as good to go in a crisis. But depending on the drug or the vaccine, there are shelf-lives that come into being.
When there's a drug or vaccine that's used routinely in medical care, you can create a stockpile mechanism that allows you to recycle those drugs or vaccines so that you don't have to just put them in a warehouse and throw them away, but that you can have the capacity to surge if you needed it in a crisis, but use those in routine care.
Something like smallpox, we don't use it routinely, so it will be stockpiled in the traditional sense of the word.
HAUER: I want to allude to a point you had made, and I think it's one of the disconnects that we've got at the federal level. As you look at vaccine development, trying to look at research and development activities on new vaccines, you have to really look at the intelligence that we're getting and try and figure out what the intelligence is and where you've got to put your money. And there is a disconnect between the intelligence community and the community in Health and Human Services in trying to understand what the real threats are.
TIERNEY: I would suppose some of that comes from the CDC and the, sort of, assessments of what's going on in other countries and what was showing up. But I also -- I guess it brings me back to the biological weapons convention. It's important that we get some sort of a protocol on this if we're going to have any type of advance notice or any -- instead of just keep making these things forever, the idea is to try and get some negotiated concept of how we're going to forestall the development, or to the extent that we can't do that, at least try to put something in place that gives us some ability to have some notice, if I'm not mistaken on that.
HAUER: That's correct.
TIERNEY: Governor, I would assume that you're -- it sounds like you're very familiar with all the local things -- the training and the equipment, coordination, and the communications structure, everything that would be needed would be expected reasonably that the federal government would pick up some of the resources for that; the local communities, I would guess, right?
KEATING: Well, yes, Congressman.
Let me postscript what Dr. Hamburg and Mr. Hauer said, because it's very important that you vacuum intelligence sources to determine what is out there and what's needed to respond to whatever the anticipated calamity might be. We do that all the time at the state and local level for man-made disasters, and everyone, as I noted, prepares and murder-boards and prepares for these disasters. And we know pretty well the kind of things we need in order to respond. This is a situation where we don't know, because obviously we've never seen anything like this.
Remember FEMA is state and local -- FEMA consists of state and local firefighters, rescue workers and the like. The FEMA people that came to Oklahoma City, for example, came from Fairfax County, Virginia, from Prince George's County, Maryland, from Sacramento and from Los Angeles and from Puget Sound and from Miami-Dade and the like -- Phoenix. All of them are local people who have been thoroughly trained to respond to, for example, building collapses in this particular case.
That's all we're saying. Once the federal government figures out what's the problem, then the book that results from that analysis of what is the problem is distributed to the people at the local level and the state level in every state, an individual and an entity that's responsible for disaster preparedness and response. And we implement the book.
TIERNEY: To the extent that the book may require that you have certain equipment in local police or fire departments or other agencies, that you have certain training exercises that go on, certain ability to have people that can communicate and coordinate these activities or whatever, would it be your understanding that the local communities would be able to absorb those costs?
KEATING: No, not necessarily -- some yes, some no. And some, for example, already anticipating certain types of natural disasters, have equipment and assets in place. But it depends on the nature of the beast. I'd say some of these costs, yes. Obviously, if there's a huge run on hospitals, there aren't sufficient resources to build new hospitals and you wouldn't anyway. You'd use college dormitories, then clear out a dormitory -- for example, remote college campuses, as we did in the scenario here.
But you have to know what it is that you're dealing with, and then you determine whether or not you have the assets in place or if you need to import the assets. Obviously, it's a lot cheaper probably to distribute those assets on a need basis, as opposed to having them in a warehouse someplace. But it depends on the nature of the beast, the extent, how large and how expensive the response would be.
TIERNEY: Senator, let me just close. I think that you're an individual known for having spent a great deal of time thinking about and weighing threats to this country in an analytical way. On a scale of one to 10, with one being a very likely scenario and 10 being least likely, what would you assess this type of a threat to this nation?
NUNN: It's really hard to assess the smallpox part of it -- whether smallpox...
TIERNEY: Well, just any type of biological...
NUNN: ... but some type of biological attack against the United States, I'd say the probability of it happening in the next few years is very high. I think that's probably a greater threat than the nuclear, although we've got to be very zealous in trying to safeguard nuclear materials in the former Soviet Union. As you know, I've spent a lot of time on that, and I think that is a real danger.
But I also believe that this dissemination of biological would be something a terrorist group could carry out much easier than nuclear, in my opinion. It wouldn't be easy. It's not as easy as some might say, but it's doable, and I think the nuclear part would be much greater because the nuclear material would be harder to get access to.
So I always have feared attack by a group that doesn't have a return address more than I have a country where we would know if, for instance, a missile were launched and we would know where it came from, and they would be, in effect, committing suicide as a nation.
So I fear this kind of scenario. I would not exclude chemical also, as more likely.
NUNN: I might just add one footnote. I now am spending a third to half my time on an organization called NTI, Nuclear Threat Initiative, but we're including the biological and chemical. We're fortunate to have Dr. Hamburg who's heading up the biological, and we're going to be determining what a private foundation can do in this area. Ted Turner is funding it. We don't have unlimited funds. The federal government's going to have to do most of the heavy lifting.
But we're looking at this early warning surveillance system, whether we can help the World Health Organization and others beef up that. We're looking at the question of best practices, safeguarding materials; whether we can inspire the scientific community in this country and around the globe to organize themselves, as the nuclear industry has done.
The electric utility industry after Chernobyl and after Three Mile Island organized, and they have their own peer reviews, they have their own safety mechanisms, not funded by the government. I think the pharmaceutical companies of this country and the world have a real opportunity here to step up to the plate and help safeguard a lot of this with their own resources.
So the scientific community is going to have to be much more aware.
And finally, we're looking at the possibility of really trying to help get jobs -- meaningful jobs for the former Soviet Union scientists that know how to make these biological weapons and spent a whole lifetime doing so but don't know how they're going to feed their families. That is one of the most crucial aspects of nonproliferation in the biological arena, in my view.
So we're going to be active in this area, but we know that the big picture has to be dealt with by the governments of the world.
HAMRE: Mr. Tierney, may I just say...
HAMRE: ... we had a biological terrorist incident in this country. People have forgotten about it. It was 10 years ago. There was a kooky little outfit out in the Pacific Northwest that sprayed salmonella on a salad bar and infected, you know, hundreds of people. And we've had it in this country.
Now, fortunately, it was, I guess you'd say, more on the scale of a nuisance, but, you know, there are enough nuts out there that want to make a point. And this is not in the realm of the theoretical, this is very real.
NUNN: Well, the Aum Shinrikyo. I had a set of hearings in '95 where I sent investigators to Japan and looked at the whole Aum Shinrikyo attack over there, which was chemical, but they were working on biological. And this was a group that had hundreds of millions of assets, they had tried to develop biological weapons, they developed chemical weapons, they'd had other attacks, and they were even doing some experimentation in Australia on sheep with biological and chemical weapons. And all of that was going on with substantial assets in Russia.
And they never had appeared on the radar screen of either our intelligence or our law enforcement agencies. We never heard of them until this attack. So it shows you the need for coordination, too, with other nations in the world.
HAUER: Yes, the Aum, on eight different occasions, tried using biological agents and did not overcome some of the technical problems that are encountered with these types of agents. But as the senator said, this was very high on the radar screen. They tried using it. They tried killing a judge with anthrax in Japan and were not able to use the agent successfully. But it's only a matter of time before some of the technical issues are overcome by some group somewhere.
TIERNEY: Well, I thank all of you for the work that you've done on this.
And, Senator Nunn, you in particular for the work you've done in the nuclear area in the past also. Thank you.
NUNN: Thank you very much.
SHAYS: Senator, I noticed you looking at the clock. It's getting a little late, I realize.
NUNN: I'm thinking of you, because you've got another panel. I've been in your spot.
SHAYS: Well, I'll tell you, this is so fascinating that sometimes you get antsy to ask the questions. I just wanted to hear you all share what you knew before we even got to the questions.
I'm going to kind of jump around the board here. I'm interested, Mr. President, when you had the thought that Iran might have been responsible, did the military step in and advocate a response? And then did they get into any question about the soldiers being vaccinated and taking up some of those valuable 12 million?
NUNN: Good questions, Mr. Chairman. Two points. One is, right at the very beginning of this scenario the secretary of defense demanded we set aside something like 3 million doses of vaccine for the U.S. military. And, of course, my first instinct is to protect the military, but after 10 seconds' reflection, the local health officials in Oklahoma City and Georgia and Pennsylvania were the ones we had to take care of first and foremost.
The scenario that we had in terms of foreign was the Iraqi mobilization of tanks toward the Kuwaiti border. And the news media speculation on Iraq being involved in this was not backed up by anybody that had any intelligence. We got no intelligence. I told my good friend Jim Woolsey, who was playing the director of CIA, that he gave me one hell of a lot of policy advice sitting around the table and not one ounce of intelligence.
SHAYS: You know, knowing him as little as I do, I have a feeling he didn't react kindly to that.
This is the 20th hearing we've had on this issue, or briefing, and I keep learning more things. Now, obviously we've had 40 government agents on the federal level. We have 3,000-plus state, county, local governments. And then they have all their departments and agencies. So we're talking about a lot of people.
I'm fascinated by this concept of ultimately, you know, we don't write a play book, so we don't know exactly what a president's going to do and what authority he's going to take and what authorities a governor's going to do. But it just strikes me that what ultimately would happen is the president will decide to do whatever the heck he or she wants, and that's what a governor's going to do. I mean, you're not going to probably question your counsel to say, "You know, do you have the authority?"
Maybe, Governor Keating, you could tell me how you would respond.
KEATING: Well, I think everyone...
SHAYS: Let me say, you might question him, you just might not listen to him.
KEATING: Of course.
Mr. Chairman, I think everyone in a public position will try to do the best job he or she can with the information at his or her disposal. And that is the problem; in this case there simply wasn't the information. The level of ignorance, at least at the local level, was very high, and the willingness to respond intelligently and forthrightly and quickly was limited by the intelligence, the knowledge at hand.
So what I'm saying is that the president, with the governors, there is a relationship, I think, generally of comity and good will. If something like this were to happen in a multi-state environment, the president will look to the governors to provide the execution, and the governors would look to the mayors and community leaders to provide for the execution of whatever the plan is to respond. And that plan has to be federally developed. There is simply no way that the governor of Florida, the governor of Oregon, the governor of New York, whatever, would anticipate nor prepare for, either with assets or with intelligence, a response to a smallpox or an anthrax attack.
But what struck me, and I made the comment at our session, was if you're preparing for war, you anticipate types of wounds that your troops will receive, and puncture wounds are what bullets create. So your people are trained, medical people, to respond to puncture wounds. If this kind of scenario is what the government of the United States feels could happen to our people, then to have doctors at the local level have no knowledge of it, no knowledge of how to respond to a puncture wound, is potentially grossly negligent.
SHAYS: Could you just touch, as briefly as you can, on this issue: Did the power vacuum get filled by a president and governor who just said, "I got to run with this"? Do you think it's possible to try to anticipate the powers that would be needed? Or do we just, kind of, let it unfold with people logically responding to a president or logically responding to a governor?
KEATING: Well, there's a combination of both really.
SHAYS: And then I'd like, Senator Nunn, for you to respond.
KEATING: Yes. I mean, there's a combination of both. I think in the case of most states our civil emergency management people train for scenarios that they anticipate will happen to their state, whether it's a hurricane or a string of traffic fatalities, the shutdown of a subway by...
SHAYS: I hear that part, I really do.
KEATING: Yes. And I'm saying that so their training, and if an event occurs, the media, everybody comes to us for a response. And in the case, for example, of the Oklahoma City bombing, President Clinton called me, we talked about what I needed, what he was willing to provide, everything just worked like clockwork because we had highly professional people on the ground. But if he didn't know what to do because he had no idea what happened, if I didn't know what happened, if I didn't know what to do because all of a sudden, you know, people are falling over dying and we don't have a clue as to what is causing this, we have a problem.
SHAYS: But it seems clear to me...
KEATING: It's intelligence, information, that's most in need.
SHAYS: Right. Right. I don't mean to disrespectful, though, I'm still pursuing this one question.
It seems to me, Senator Nunn, that in the course of your exercising your responsibility as president that you basically decided to make some decisions without necessarily knowing whether you had the authority or not, because you knew somebody had to make them.
NUNN: You have to make them and you have to just step up to the plate and swing and take the best swing you can, because at that stage you don't have time for a legal research job, you really, you have to swing. And you have to have a partnership with the state and local.
And I think that's going to depend in the future about whether FEMA can take this ball and really roll with it. I'm one who believes FEMA has dramatically improved in the last few years. But they're going to have to basically have a lot of support in the White House, because they've got to cut across agencies and they've got to do a lot of groundwork with their counterparts at the state level.
If I'm dealing with Governor Keating in this crisis and he's back home and not in the National Security Council, which would be probably the more natural event, then the question of how well FEMA has prepared with his people in advance for this or other type scenarios would be important in terms of how well he and I would be communicating.
NUNN: Now, we'd be getting feeds from our own people.
SHAYS: And obviously, Governor Keating, there's not a person in this room who doesn't know the experience you went through. So you bring tremendous expertise. In that case, though, it was -- which is true in a chemical attack or explosive, conventional or even nuclear -- it's pretty much there. What a president is wrestling with, what you wrestled with is the sense that it goes outside the city, it goes everywhere. So it introduces so many gigantic question marks.
Maybe I could ask the other panelists as well, if Congress were to decide the power of the president or the power of the governor, in this case, my concern would be that we would start to get into an issue of, my gosh, we have civil liberties here, which is obviously important, but then we would try to write a scenario that would respond to both sides. In the end, we might lock a president in.
Is the ambiguity almost better -- and then I'm going to get to another question. I'm still on this question. Is the ambiguity almost better because it would be hard to write -- maybe Dr. Hamre, you could respond first -- it would be hard to write a scenario without getting in gigantic debates about civil liberties and so on and so on?
HAMRE: Sir, I tell you what, I walked away from one conclusion that was overwhelming in my mind, and that is, why we have elected politicians who are national decision-makers at a time like this. This is now where all of the issues that are so central to how we love and want our country -- freedom, liberty, opportunity, security, they all collided together. And we don't entrust the ultimate authority to make those decisions to anybody else except politicians -- politicians who are accountable to the electorate.
In that sense (ph), the people who are making the decisions at this exercise were the two people who had faced the electorate, had worked with the electorate and felt accountable to the electorate, that was the governor of Oklahoma and the president of the United States. That's where it really belongs. I think you're trying to overly engineer in isolation the solution to how you're going to handle a crisis when you're in a wartime environment. This was a wartime environment. Any other way would be a mistake. Leave it to the people who we've empowered to be making decisions for all of us. And I felt in good company having them make the decisions.
SHAYS: Mr. President?
NUNN: I would just add one other thing. I do think it's important for this subcommittee and the full committee and the Congress to anticipate some of these broad scenarios in determining how much authority you want to give to the president of the United States and secretary of defense and others. We did that when we passed the Nunn-Lugar legislation in '91 on the question of bioterrorism in chemical. We gave more authority and had some waivers of the posse comitatus statutes back then. I'm not sure of exactly -- and I'm sure that needs updating. It was done years ago, I believe, under the Reagan administration, in terms of posse comitatus waivers, use of the military in nuclear scenarios.
But I think some of that really needs to be fundamentally though through here. Because if you don't have any authority and the first day the president has to breach what some may perceive to be the existing law, then where is the line after that? As hard as it is, I think you need to try to tackle it, because when you get in this, sort of, situation of any president of the United States and any governor is going to be asking questions -- What is the law? What is my authority? They're going to ask those questions, and they must. But if they get an ambiguous answer back and they don't know, they're going to seize the authority when the lives of millions of people are at stake.
SHAYS: But I will say something even more. Even if the law were in contradiction to what a president's instinct was, if the end result was a very good decision, ultimately, for the survival of our nation, I hope to God that president makes that decision.
NUNN: I think he would. I think he would need to explain it to the American people very carefully, though. And I believe that the question of how far you were into the scenario would be all important. The hardest thing for a president would be to take that kind of action before the people knew there was a serious problem.
SHAYS: I'm struck in all the work we've done and with terrorist issues, that terrorists want to disrupt almost more than they necessarily want to kill. I mean, the potential terrorists attack on the tunnels in New York where, you know, you would have flames coming out both ends -- the question: Would people ever go in those tunnels again and what would that do the commerce in New York? Those kinds of things have such a long-lasting impact.
The Gilmore commission -- getting to Mr. Gilman's comments about reorganization and lines of authority and so on -- advocated a central office to coordinate a domestic response to terrorist attack with clear budget authority and intelligence capabilities. The Hart-Rudman commission advocates a centralized office called the Home Office. Frankly, it's a term -- and the more I thought about it there's so much logic to it -- the Coast Guard and FEMA and so on. But it still raised the question as to what authority? Still had to come to grips with what authority -- budget authority, you know, what kind of line authority do you have and so on.
And, Dr. Hamre, your organization has also called for centralized coordination.
SHAYS: In the end, would all the panelists -- and if there's a disagreement here -- agree that we have to have a much more centralized control with budget authority, with some line responsibilities, with a clear, more than a drug czar, with some clear ability to dictate budgets on other departments if it relates to this issue?
HAUER: Yes, I think that that's essential. I think that the fragmentation we've seen at the federal level has really hurt the country's preparedness. The majority of the money over the last four or five years has gone into buying toys for local governments for chemical response -- for the lights and sirens response. CDC and HHS in the last several years has, you know, worked hard to try and begin to rebuild the nation's public health infrastructure, but that's going to take some time.
The issues that we confront in preparing for biological terrorism are completely different than the issues we deal with in preparing for chemical terrorism. I think it's very important we have a central focus at the federal level that can have this over-arching approach that looks at chemical, biological, nuclear -- the use of dirty bombs is a very big concern at the local level; not nuclear bombs, but dirty bombs.
We need to have one point of contact. We get mixed messages from various federal agencies, and have gotten mixed messages. When I was still in my capacity in New York City, we could call three or four different federal agencies -- the Justice Department, FEMA, HHS and DOD -- and get different training. The training was not necessarily consistent. Different programs, different recommendations, different recommendations on equipment. And we found it to be very inefficient and very ineffective.
A lot of that is changing. A lot of the program in DOD has moved over to the Justice Department. But realistically this should be housed in a central location. My opinion, it should be in FEMA with strong support from the White House. And then that the other agencies should be working through FEMA, so that there is one voice at the federal level, one coordinated plan at the federal level and that money flows in a coordinated fashion to the state and local governments.
SHAYS: Let me conclude, just with an observation, and not to -- Mr. Tierney and I agree on many things and we sometimes view it slightly differently. I had met with Ambassador Maley (ph) on more than one occasion in Geneva and here, and during the Clinton administration. And he had tremendous reservations about the protocol, not the convention, on biological weapons. In other words, we have a convention: We're not going to make biological weapons. The protocol is the challenge. How do you determine whether countries are doing it?
And my observation and my view is that the protocol would provide minimal inconvenience to the bad guys and ladies, and cause tremendous problems for those who wanted to abide the system in an honest way. So I would have probably predicted that this former administration would have had gigantic questions about (inaudible) the ambassador has done the protocol. And I sense that -- at least my observation is that, the policy isn't all that inconsistent, but time remains. And I could be wrong in it. But that's my sense.
Mr. Kucinich, would you like us to go to the next panel? Is that all right?
I don't know -- there was probably a question or two we should have asked that some of you might have prepared for. Is there a question that you wished we would have asked you that you thought important enough?
HAMRE: Sir, you have a wonderful panel that's coming next. And I'm not trying to get us off the stage, but you need to hear from them too, because they're actually the first responders. And I think that if there are questions that come to you that you would like us to answer, please route them to us. We'll make sure that everybody gets them and we can answer them.
SHAYS: I am very grateful to you all of you for being here. Thank you very much.
And we'll go to the second panel.
NUNN: I'd like to thank you and the subcommittee for your leadership on this issue and not just today, but going back in the past. I think you have really been the voice of asking the right questions, you and the subcommittee. And I congratulate all of you and hope you continue it.
U.S. House Government Reform Committee's Subcommittee on National Security, Veterans Affairs and International Relations held a hearing on the biological weapons threat. Witnesses included Senator Nunn and NTI Vice President of Biological Programs, Dr. Peggy Hamburg.