Panel 1 of a Hearing of the Senate Health, Education, Labor & Pensions Committee Subject: SARS

PANEL I OF A HEARING OF THE SENATE HEALTH, EDUCATION, LABOR & PENSIONS COMMITTEE
 
SUBJECT: SEVERE ACUTE RESPIRATORY SYNDROME (SARS)
 
SEN. PATTY MURRAY (D-WA): Well, thank you very much, Mr. Chairman, for having this hearing, and Dr. Gerberding, for being here as well. You've been really good about your time. I've had the opportunity to talk to you about this issue several times as a member of the Labor/HHS appropriations committee, and I know you're really working hard to make sure we have all the information. And I especially want to thank our friends from Canada, Toronto, for being part of this today. I think we have a lot to learn from them, and frankly, any of us could be Toronto, so it is great for them to share their information and help us learn what we need to know as well.

I just have a couple of questions, Mr. Chairman—I know you want to get on to the other witnesses. And Dr. Gerberding, I continue to be concerned—I know we provided $15 million in emergency supplemental to address the SARS outbreak, but I'm concerned whether or not that's sufficient funding, and whether or not CDC has shifted resources from other infectious disease prevention efforts so we can focus on SARS and whether or not diseases like TB are being underfunded because we have this focus now. And if you could respond, I'd appreciate it.

DR. GERBERDING: When we started the SARS outbreak, we were in the midst of Orange alert in our country because of the war in Iraq and other issues then. So, from the very onset we defined the mission, the goals of the mission, but also defined the strategy as being one characterized by parsimony, and that means trying to be right-sized in the personnel and the amount of engagement in SARS that we were committing, particularly in the international arena, since we had the expectation that we could be called upon to deal with a second threat or something related to terrorism.

Since that was the characterization of the response from the beginning, I think we've been doing an efficient job of managing our human resources as well as our dollars, but clearly this is a large effort and the $15 million appropriation was really critical to our success. We anticipate that some of the $15 obviously needs to go out to the states and local agencies who are directly impacted by this as well, so it's not just there to support the CDC infrastructure.

The impact on other programs on CDC has not been zero, but we've mitigated, I think, any major impact by rotating people in and out of the SARS effort, not taking somebody from another center and keeping them engaged in this over the long haul. So, our management has been designed to allow a comprehensive set of experts from across the agency because it takes everybody, not just the infectious disease people—it takes occupational health people, it certainly takes the communications team—we had to activate our emergency communications systems—but when people get detailed to SARS, they are there on a time-limited effort and then they go back to their regular responsibilities so that we can minimize the impact. But I certainly couldn't say that there's no impact at all.

SEN. MURRAY: And I think we just have to be really careful of that balance as we go through this.

The other question I had is really one of communication because, as Dr. Frist said, there is no boundaries on disease. And I know my home state, Washington state, has a great public health prevention system, public health strategies in place, but, you know, not all states do. How are you monitoring communication between states to make sure, because if somebody gets infected in one state that's in a city right next to another one, you know, very quickly it can progress that way?

And also internationally, you know, Vancouver, B.C. is very close to Bellingham, Washington, and there's, you know, hundreds of examples like that across both borders. Are we working internationally with other governments as we hear about these cases, and communicating back and forth between states, localities, and actually internationally?

DR. GERBERDING: Now, in terms of the domestic situation, the strategy for integrating information across state boundaries has relied primarily on the weekly, or daily sometimes, conference calls that we have with the group of state health officers, and Dr. Selecky is obviously a major leader in that.

SEN. MURRAY: Does everybody participate in that?

DR. GERBERDING: Most of the states participate most of the time. You know, there's not—at any given time, not all 50 are on a particular call, but in addition, that information is posted on the Internet, and we have health alerts that go out broadly throughout the system whenever there's anything new. And we also have a connectivity with the public affairs officials in each state that link back to CDC and with each other. So, we're working very hard to maintain that seamless integration.

Internationally, we have a CDC staff member at Health Canada and a Health Canada staff person in our operations center at CDC, so that's been a great help to us in having free exchange of information back and forth. And I—we're going to do this every time because it has made so many problems disappear.

We are—have special groups of people looking specifically at border issues, and because I think there is that international boundary where, for example, planes often fly to Vancouver before they come to the U.S. and so forth, so those very specific cases of a need for greater integration are handled on a situation-by-situation basis. But, you know, we can always do more, and if you have ideas, or if there are gaps that come to your attention, we definitely want to try to resolve that.

SEN. MURRAY: Okay. Very good. I really appreciate that. And thank you very much, Mr. Chairman.