>> c-span2 providing live coverage of the senate floor proceedings and key public policy defense, and every weekend booktv, now for 15 years the only television network devoted to nonfiction books and authors. c-span2 created by the cable tv industry and brought to you as a public service by your local cable or satellite provider. watch us in hd like us on facebook and follow us on twitter. >> on this wednesday when we're live at the hudson institute with the blue ribbon study panel on biodefense is holding a meeting. they are expected to discuss effective prepared is response and recovery from biological and chemical threats. panelists include former members of the intelligence committee, first responders, doctors and health policy official to the blue ribbon panel was established to recommend changes to u.s. policy in law to strengthen the nation's defense is biological and chemical incidents. the reports will be issued this

spring. live coverage on c-span2. this is expected to get started in just a couple of moments. [inaudible conversations] [inaudible conversations] [inaudible conversations]

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[inaudible conversations] [inaudible conversations] >> we are live at the hudson institute for discussion on effective preparedness, response and recovery from biological and chemical threats. at a long discussion includes the blue ribbon study panel blue ribbon study panel on biodefense but among those you will hear from former connecticut senator joe lieberman secretary tom ridge, former senator tom daschle and former hhs secretary

donna shalala. this is expected to start momentarily. [inaudible conversations] [inaudible conversations]

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[inaudible conversations] [inaudible conversations] >> again we are live at the

hudson institute this morning waiting for the start of the discussion on biodefense but it should get underway in a couple of moments. while we have a second we will tell you about some of the other live programming coming up. beginning at 10 eastern on c-span we'll go live to the brookings institution for discussion on the iranian nuclear talks looking at diplomatic components of a credible do. iran's objectives and concerns and the politics of the united states. after the program for panelists will take audience questions. bent on c-span3 at 10:30 a.m. the center for strategic and international studies will host a discussion on defense and national security undersecretary brad carson will talk about the armies of vision for the role of land power in future operations. he will also talk about the armies approach to innovation and technology. that is on c-span3 starting at 10:30 a.m. eastern. at noon on c-span the alliance for health reform talks about health care costs.

since 2013 there's been a deceleration in spending for private health care insurance, medicare and hospital care. this briefing will discuss health care costs and the prospects of the future, also cost-cutting strategies. that's on c-span again starting at noon eastern. more on the iran nuclear negotiations from the world affairs council. that is at 6:30 p.m. eastern on c-span. to hold a discussion on hold or disciplined for an iranian nuclear deal. [inaudible conversations]

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[inaudible conversations] >> folks, we're going to convene in about three minutes. [inaudible conversations] [inaudible conversations]

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>> everyone take your seats, please. >> everyone take your seats, please. appreciate that.

well, good morning, ladies and gentlemen. on behalf of the blue ribbon study panel on biodefense, we welcome you to the fourth public hearing related to our collaboration with the hudson institute. i think it's very important for us to publicly express once again our deep appreciation for the sponsorship of this panel, and, frankly, the resources they provide to us to take on will be considered to be a very very critical mission as we take a look at our ability to identify and respond to one of the more sinister threats that exist out there, whether it's don't have us by mother nature or isil or a nation-state or whom ever that actor or actors may be. so again we are deeply appreciative of the hudson institute. and while this is the last public meeting we will conduct year there will be some private meetings here as we develop a

series of recommendations to submit to the congress of the united states are both short-term and long-term activities recommendations relative to the ability of this country to identify and respond to those kinds of threats. today we confront a very troubled world and it becomes more challenging every week. while many issues threaten our nation, biological and chemical threats are among the most sinister. al-qaeda, isil and other terrorist groups have voiced their desire to obtain and use biological and chemical weapons. and lone actors crude terrorist camps with agents like ricin are reported regularly. further the ongoing ebola crisis reveals significant gaps in u.s. public health and medical preparedness. last year's chemical attacks in syria prompted a serious consideration of our own ability to respond to domestic chemical

terrorism and an influenza pandemic continues to lurk. it is clearly necessary to consider our current ability to defend against such threats and provide the health and welfare of our citizens. i am privileged to co-chair this panel with one of my friends senator joseph lieberman who unfortunately will not join us today, is a little bit under the weather, and we will proceed without his wisdom and his council but he has been so involved in the first three meetings and obviously, will be involved as we develop a set of recommendations to centerville. just for the benefit of the audience am ever grateful that she's been a think enough of this panel to becoming a today i would like to outline what we tried to do in dividing our efforts alone three four for specific panels, issues that relate to our effort. the first panel we held several months ago was a threat awareness. we took a look at the potential risks associated with biological

and chemical threats that can afflict potentially catastrophic consequences. we discussed the risks posed by the states, a nation-state and individual actors its first panel was just about the general nature of threat awareness. obviously, the second panel was prevention and protection. and so we asked a series of panels to give us their overview on everything from biological arms control and cooperation with bilateral multilateral agreements, to first responder protection and agricultural defense. ever took a look and assess our people and pandemic influenza response and our capability to respond to future pathogen. the third panel involved expert to talk to us about surveillance and detection, and understanding of the biodefense required in this critical area. we took a look existing

technology and its effectiveness. we examined the challenges associated with early detection and early diagnosis. and we took a very interesting look at a human and animal interface as relates to our charge on this blue ribbon panel. entity we've got a very very lengthy group -- today -- subject matter experts to talk to us about response and recovery capability. and so we think we've covered the waterfront from threat awareness to response and recovery and everything in between, and it will be our mission today, ken weinstein and donna shalala and tom daschle and i think jim greenwood will join us later to submit to the congress of the united states a series of recommendations and hopefully we will be in a position to be out there advocating for these recommendations on a personal basis as well. so as we've done with every panel and every meeting, we normally begin with a unique

perspective. and to this extent we have mike rogers, former congressman obviously if you're for me with the hudson institute, even if the work is done and the world international community, terrorism and the like we think his perspective to commence this final panel would be very helpful. so congressman mike rogers, and you for joining us. the floor is yours. >> well thank you, governor, secretary. a lot to get on a card. i will caution that's funny, really, it is. you can laugh. it's different enough inside -- >> you bet. it's a lot better last night i discovered that as secretary, mike. thank you very much. >> exactly. but i do praise the the opportunity and appreciate the work of the panel and i want to say i have been with hudson now for a couple of months and the intellectual firepower there is both inspiring, and i've learned a tremendous -- you come in

fairly well schooled and you realize you've got a long way to go and hang out with my fellow colleagues at the hudson institute. they are doing really, really powerful work. i just thought i would tell you our journey all of it on how we in a bipartisan way got to the bar to build and the pop-up bill on issues that we saw coming up that we didn't believe were going to be addressed because it just is hard to get people's attention about something you can't see or you can touch and necessarily but, you know, the devastating consequences. there are many a nights as chairman of house intelligence committee you don't sleep for things that you know. often centered around our threat matrix of bioterror attacks and our ability to respond in a way that i think would be completely appropriate. so anna eshoo and i started in 2006 after a series of

investigative is too strong but at least inquiries into the status of terrorist at least attempting in their interest in obtaining bioweapons. what we found was there was a high degree of interest in obtaining weapons but were in the middle of the conflict in iraq. we were busy in the middle of the conflict in afghanistan at that point. and the focus was not just necessarily where it needed to be. so looking back at the white house at the time the bush administration collectively with an issue, mike rogers republicans working with the white house, we agreed that we need to have a special fund our effort to try to produce countermeasures in a mark where there was no marketplace for. that was the biggest problem. there's only one single customer in reality for these countermeasures. so i don't care if it's radiological exposure. i don't care if it's smallpox on a large scale, bubonic plague

which would seeing strong interest in terrorist organizations trying to weaponize the bubonic plague and try to find delivery systems for them. we realized we needed to have something on a larger magnitude to both stockpiles of this than to try to push it up to our first responders or in communities where first responders could gain access. that's really how this started and you can imagine with all of the of the challenges facing the united states it was hard to get peoples attention on this. i credit yeah and as you again, my partner in this, and the white house person yes this is something we're going to have to do with -- anna eshoo -- in the levels of threat we see, even given all the other things we are. the one challenge we had subject to its passage was trying to get full funding for. so we got plenty of authorization money set aside for these countermeasures, and it was very, very tempting as you know, governor ridge, that

that money was just too tempting to be moved somewhere else for what they would proceed bigger parties. and begin because the enemy was not knocking on our door with the bubonic plague or smallpox or fill-in the blank we know they were interested we know they had aspirations to use it. we knew they had aspirations to put it together but we didn't have enough to say, you know within 30 days or 60 days or 180 day something bad is going to happen with these biological weapons. it always became a backseat issue. we've had some successes along the way, however, with medical countermeasures. hhs just signed contract with emergent, about $31 million for the new and improved anthrax countermeasure. and a lot of attention paid to it but there was a recent there was a lot of attention paid to it. because we watched a terrorist pay a lot of attention to it. so we wanted to make sure that we had stockpiles of countermeasures around the

country that could address a problem if it happened to survivability rate in those cases would go, is astronomical. that money will also be used to test the prophylactic capability of anthrax after measures pick we think that there can both be prophylactic treatment which easy now and our response treatment to anthrax. in other words, if somebody gets exposed, there is an opportunity that we can have a vaccine that could say that persons life. so all of that to me has been it's been a slog a work in progress, but i think we have made some progress. and i know anna eshoo with susan brooks, a republican from indiana, signed a letter to the chairman recently requesting i think 400 some million dollars in additional money to the fund. i think if they can get anywhere near it i think it would be a success story. we are going to have to continue to do this to try to stay ahead

of the threat. the last thing we want to do is have a successful biological attack in the united states, or with our allies, in not be in a position to respond. we saw the panic across europe, across the united states really across asia, the middle east africa about ebola. this is something that we knew had the possibility to happen but were not willing to stand up and try to prepare ourselves for the eventuality that it might happen. and so there was a lot of chasing our tail in the beginning. if you watched the with the government reacted they reacted which is great the problem is that a lot of catching up to do in a way which an advantage of if both pop and barda pieces of legislation have been fully funded and operational. this was a bipartisan problem on full funding to it started in the bush administration. that money got yanked away and its continued into this administration and again it's just hard to get people's attention on something that sounds really bad but i can't

see. with that mr. chairman a be willing to take any questions with advice of counsel, of course. >> surrounded by lawyers. i know you're very reserved. i think we all have several questions. i would like to dig a little deeper with regard to the observation you made in terms of generating bipartisan support not on the authorizations i put on the appropriations side. as chairman of the house intelligence committee you obviously were far more familiar with the intent, the aspirations and the capabilities of the terrorist organizations is because of your role and under multiple briefings that you requested -- you learned a great deal from each briefing. and against our challenge is that in a democracy as we talked a little about at this point we

are much more reactive than printed. you're saying that the challenge that people understand but since it's not a needed and it's not visual, rallying congressional support around and issue or an organization that is critical to this by defense countermeasures and chemical countermeasures is very, very difficult to do you have any recommendations in that regard as to how this panel may take our recommendations and approach the congress of the united states to elevate not only their interest but also their ability and the willingness to take some of these are conditions because they are bipartisan, a political recommendations, take them seriously as if we can change relationships between entities, change the funding streams can any thoughts in that regard? >> yeah, i think anytime a number is educated on the aspirational interest of terrorists, that's a good day for an outcome of trying to get ahead of the problem. so i think the report will be important to that end, and i would use this as an opportunity to get senior staffers to get

members of congress clued in on to the aspirational nature of terrorist attempts. in some cases it's gone beyond aspirational intent. we sing the use of chemical weapons. we know people are committed to using them. we have seen the procurement from isis individuals into beasts, we believe of obtaining at least chemical weapons, if not gain access into what research may been done on biological weapons. and so that's a very dangerous combination. in addition any radiological material that may have, a lot of people are afraid of of the nuclear bomb, and we should be but a radiological dirty bomb is much more in the capabilities of a terrorist organization than a nuclear bomb, certainly at this point. that is concerned. and so i think if members get clued in and senior staff get clued in as to what the threat level really is i think it's easier for them to start making these decisions. there's going to be a lot of

priorities, especially on defense but we have been robbing maintenance programs on carrier groups and aircraft and heavy machinery, tanks, to pay for other things in the military. so the pressure is going to be on the defensive side. we had to make this a public health issue i think here in america and try to get it out at the defense stream as best as we can. and activity of that magnitude even so, think of the radiological bomb that has the impact of eight square blocks. for a small amount of until burst in a way that produces an outcome that they desire. most of the impact of that is fear and chaos but it's not actually damage. and so this is the problem that we confront. can we sustain psychologically in the united states or economically an attack that even that small magnitude? or a small magnitude biological attack of smallpox, or we know they have this strong interest in the bubonic plague trying to weaponize, which is difficult to

do but not impossible. and if give engineers and capability to be able to pursue that, and now they have a little open space to pursue that. again that would keep me up at night. that kind of conversation with the members outside of national security committee space i think would be really valuable. if you're an article to our what about agriculture but if you're and commerce you what about commerce the this is an american public health problem that we're going to have to deal with. >> congressman, if i remember correctly we met first when you are a state senator in michigan. >> you have a great memory, madam secretary, my gosh. i think i had a mustache still then. i hope you didn't remember that. >> the states have a role, and if the governors and state legislators are recognize that and made some demands on their own congressional delegation it seems to me that would help that we've been talking about the infrastructure that's needed and

it's not just a federal infrastructure. could you give us some insight how you think the states we can mobilize the states to also see themselves as part of this overall infrastructure that we need? >> thank you, madam secretary. again, great memory. that's a shocking you would remember the. i'm sure i look exactly the same. i know you do. here's i think this is a great idea. most states have gone to some counterterrorism position in their state governments. so that they realize that the issues they're going to have to address if they were going to be coordinating an effort with first responders coordinating an effort with their hospital systems, and in for an item. ..

and again all of them have different titles, but they are counterterrorism positions engaged in this conversation. and should be actively working now to talk to their congressional delegation talking to the senior staff about what their needs are. it can't be they need a fire truck. it has to be we need to be prepared when emts show up or

firefighter show up to a scene or there may have been somewhat of a biological weapon. it has to be with the individuals who take the burden of that first response. >> so our recommendations are to include a role for the state. >> absolutely. that's a great idea. >> it is a different coalition when you add state government. >> that's exactly right. they won't necessarily have the resources and they can be great advocate for their measures to be deployed. one of the things i found after 9/11 is everybody wanted everything all at the same time. it is not possible so you do have to put a threat matrix together and says the upper peninsula of michigan in this important place for me, but maybe it doesn't rise to the level of getting the first 10 tranches of money for terrorism. >> he says that now that he's out of office.

[laughter] >> i couldn't have said that probably three months ago. what i really meant is upper wisconsin. i would like to correct the record if i may. so this is the challenge he will have as well as the legislators have is making sure when there is a good idea candidly if we are not doing new york city and los angeles and places that we know are an immediate hit list they shouldn't get it all but they should also be pretty high on the priority list because they know those are targets for terrorist activities. it doesn't mean the other ones aren't in whidbey. but that is the challenge. that's how you engage the legislators, but all of them have to be a part of the conversation. >> that is a great comment. uni and i'll must have been able to have this secure. you can't do it from a fiscal point of view. you can't do it from a cyberpoint of view. you can't do it from issues to

talk about. there is no important relationship from the governor, former governor. you can secure the country from inside the beltway, so how we reach out to engage the governors in the big city mayors and their adjutant general's is absolutely critical. >> across the board for all the threats we face. not just this one. >> may be going to some of these governor presentations would be really helpful to play a role in the democrat version republican version, but i do them all. >> the organization of state legislators. >> was a great tip for the panel relief in the study of having staff participate and try to draw people in that way. >> thank you. first, thank you for your comment today in your long distinguished service to the nation. one of the panels later on today is going to focus on leadership in this area and sort of assessment leadership has been

and what it hasn't been over the years. you talk about the fact there is a lack of focus and a sufficient level of concern about what is a real serious threat. at the end of the day of the executive branch has got to carry out. the executive branch has to maintain the strategic focus on a threat like that that might not be won on the front pages every day. you have a front row seat for a number of years watching the executive branch and the function or dysfunction of the executive branch as it relates to this issue. there have been proposals over the years for a wmds are at the white house, for different positions in the interagency process to raise the profile of this issue and raise coordination among all of the stakeholders in the executive branch. do you have any thoughts about where there might be gas right now in terms of leadership

within the executive branch, structural organizational changes you might recommend an assessment of what you've seen that has worked in the past and hasn't worked in driving the executive branch. >> anecdotal story. when we first decided we better get engaged early on based on the threats we see across our desks we said why don't we get the bio defense the administration come in the executive branch guru on bioterrorism. that is the same look we got back. we know people who are experts on and they were. but there really was no coordinating affaires. and this is what i found really interesting in the bio measure of bills reproduced, we still had one flaw that we were never able to get over. now we asked people in age to every single in serious matters of health to deal with something that has to do with terrorism that is a little out of their

lane and obviously they understand the medical consequences. it was out of their link to figure out i am worried about keeping my hospital emergency rooms open. why am i worried about this? it wasn't a bad thing. i think there is some value in trying to find someplace to go coordinate all of the information of threats and integrate with the public health side. there's also a difference of opinion. not necessarily difference of opinion but a different attitude. if you are in the intelligence business in your design is to stop threats against the united states, this is your job to worry about this, if you are a public health person worried about all the other things on your desk right now, this is probably pretty low. and so how do you reconcile that? there is probably a little cross-pollination would be good to have some of the ability for hhs folks to have the odor of

some -- exposure of the classification of threats on bio defense and have the opportunity for intelligence folks to be over there. every time we do this it comes that they all it comes with a whole organization that comes with. secretary ridge wouldn't know anything about this. i get nervous about saying let's do a single point of contact that has all the authority. you can push it a different way and ask your secretaries to find out who they want to appoint as the point person on these issues. i think that if a management function that works in the private sector the public sector as long as somebody no-space been appointed with the authority to cross pollinate on these issues. they always like that bit of authority. saying you are the person on this venue will work with this person or this position and

intel. they will work with this position and fill in the blank whatever department that makes sense. i think you can get much more out of it. as a regular management structure have debriefing come back to congress. it forces them to go through the process did making sure relationships work. it will get a lot cheaper. >> we continue to struggle with the coordinating the effort you mentioned. i can also speak from experience one of the ways to effect change in this town as you control the purse strings and whether or not this person should end up being part of omb as they go out and deal with dollars, but we are grateful for your thoughts on that regard because that kind of interagency collaboration is critically important to the absurd because there is so much jurisdiction of overlap. as you pointed out priorities on jurisdiction very

dramatically. >> that is why we have to always come into a common -- it's really by design of the departments. they are designed to solve these problems and these are nuanced problems that don't exactly fit. >> the committee structure also doesn't lend itself to integrating funding. >> the congressional committee infrastructure doesn't lend itself too much productivity these days. it is just maddening to me, even the dni has something in the order of 22 committee siesta show up and testify. candidly, congress needs to get its act together. we are good at telling everyone else why they had to get their act together. if you want to be bold in your report you may suggest not to fix the whole thing because that gets you in a lot of trouble, or to try to limit for a reasonable number of cross committee reports. how much staff time do we spend

in these departments trying to get ready for those briefings? any big event that happens we lose the dni for a period of a month coming up to 22 different committees, some which will have jurisdictional impact of which you would want them to be in front of his time you scratch your head and say now why is he there testifying? what are we getting out of that? what productivity is happening? that may be a blue ribbon panel. >> dni only had 22. secretary of homeland security has over 100. we have to take a look at the restructuring. it's not such a bad idea. >> it will be a great blue ribbon panel and enough itself. even if you want to streamline how this gets done and forces the management structure of the relationship you could do it but you'd have to do it with a much smaller number of committees so you want bending

all of your time briefing the hundred committees. by the way all the committees will focus anyway, which is the other part of the problem. you can't get any focus because it so broad and you'll spend your time up on the hill -- not that it isn't fun and delightful to do that. >> it's much more fun when you're on top of the dais. [inaudible] >> -- the challenge of the counter members and one customer with barta at hhs. can you talk a little bit about how barta is working and i'm not interested in assigning question, but whether barta is doing the job of the united states? >> great to see you again. great to work with the whatnot. that is a difficult question. in the beginning we at

countermeasures that existed that were looking for outlets. now you have a new funding stream and they are trying to plug and staff. it is all good. they have a lot of deadly costs and development of products. your point is that is the most efficient way to get countermeasures that is pretty sophisticated. if you recall at that time there was a big debate on anthrax and the next generation of anthrax that didn't require the number of shots. i forget the exact number. 13 if i'm not mistaken, which is a long, tough process, was pretty difficult to convince first responders to go through this regime. the military didn't have a choice. you are told you're going to get it. you get it. first responders were saying tanks, but no thanks. to the process in another south slow down the next generation of

anthrax? i think we finally got over that last hurdle. the last round show they got the hint they have to use cap up their game. it is now a much different, much more efficient prophylactic measure they can apply. it may be down to three. i shouldn't say the numbers as i don't know them well enough to go there. that is something that we will have to always watch on the value of the money. you do want a slice of the money challenging the next generation of countermeasures, much like the market would do one of tone. without the market push, it is not going to happen. the fun has to operate in a way that takes money and says we are willing to bet on the next generation product and you have to improve your product or will go in another generation. without the market pressure, i worry that the outcome will be

mediocre countermeasures for 20, 30 years. >> so what% which you assign the future aquatics >> i would have to think about that. one of the things we didn't have the beginning is in a stockpiling of countermeasures. so we had two problems facing us. congress and the administration you didn't want to not have the appropriate level of countermeasures stop pilot in case there was an event and we knew that terrorists were interested in this particular anthrax was sent in their interested in. anthrax is something they can produce here in the united states. all of the problems that went with it were concerns. so that when you have to almost take an individual case. we needed stockpiled anthrax. we said if we don't do this yesterday, we are making a big mistake. then the push came then there's this new generation with anthrax

vaccines and fill in the blank. that is when you start asking yourself, when we had our stop of number, is that the time you can free up more percentage for the next generation. if they have a five-year contract, it may not be yours in five years. you have to work on the next generation will take the money and invest in other companies. i would also base it on what the threat is. i am nervous about the bubonic plague. they found six computers not that long ago. this is something they are thinking about and if they think about it we have to think about how to react to it. all of those things are going to change and what percentage i'm not sure i'm qualified to be accurate. >> thank you for your work by the way. really good work. >> thank you for your service. dr. libby. you said something which i think

was? important but i want to make sure i understood properly. i believe he said terrorists now have open space to pursue this area. what did you mean by that? >> if you look at isis today, they own and occupy land about the size of indiana. so when you have that much opens base, and they dictate government facilities, that presents an opportunity for them to be more engaged in development than i'm comfortable with. by owning that much space, you can see that it's not going well. any comments to the contrary are not accurate. they continue to hold ground. they continue to push back. they continue to frustrate opportunities to disrupt their ability to add research and development centers. right now they have research and development centers and i argue that it's a dangerous combination for us and our european allies. that is what i was referring to >> today they have the ability

to do these things since they were back in afghanistan in 2001. >> i would say this is worse than 2001 because in afghanistan they had freedom of operation in a way to plan events. now they have capability for the research and development part that they would work really hard in this area is for the capability. in other words the capability in the tribal areas about pakistan and afghanistan than it used didn't mind it so. you can do pretty rudimentary stuff. it is dangerous in and of itself. it is a planned physical attack. here you have the opportunity to do the because you have an infrastructure, electricity 24 hours a day. you have access to engineering materials and chemistry in the way you wouldn't have before. lab space, wet lab space all the things that make you cringe a little bit if you think about

what comes out of there and the intended purposes. the longer they are freedom of operation that contains those elements, that is dangerous to the united states and european allies. europe first i would argue. >> anything else? >> congressmen rogers, we heard before that members interested in this issue sometimes have trouble getting a full picture of biological threats and the consequences of biological threats. sometimes they get different refrains and hear different things. you have a deep knowledge and have been focused a long time. do you have suggestions how to get a more comprehensive picture of the problem before members of congress in a consistent way of? >> i'm going to be very candid here. the big administration briefings to the whole house i find in most members will tell you if they are being candid, not how

you. they are trying to hold back as much as they can. you've been in those briefings. they are hard to do in a group that day. some people are interested in the issue in some people would get up and ask you the bridge and fill in the blank of why haven't you protected that. some of these things you scratch your head. you have to find a aspirational interest of terrorist groups. when i was chairman, we tried to do this when i had -- i can't believe i'm going to mention this, the nsa leak issues to get members not in the national securities case connected to what the facts were about what happened, what does the government do in a way we could protect sensitive information. i found that to be very valuable. so we cross pollinate it. again you don't need cabinet level officials to do those

briefings. you need operational people giving those briefings you can ask detailed questions technological ones. some cases might be the cabinet secretary in some cases it will be well below apolitical appointed position. these are working and we found that putting them in a room and in smaller groups they felt comfortable in asking a question. i certainly don't want to look like an which is why you won't see me asking complicated questions about agriculture. i'll leave that to someone who knows better. you have the opportunity to ask a question in this meeting, in a classified setting, where they can feel comfortable having known and exposed to this. you can open up the security clearance a little bit. open the aperture in the way they have a better understanding about why folks worry about the things we worry about.

that is a much better way to do it. you can also do it through the hudson institute, think tanks. you just won't have the nitty-gritty classified portion of it. but you can give a strong historical look based on what we do know today. there's a lot of it out there and what the aspirational threat is for staff. we shouldn't ignore that. staff and members willing to participate in a way that is easy for them to get their short and impactful. i found it was valuable. #-number-sign it was valuable. >> one final question dr. alexander. >> congressmen, a follow-up on your point of developments for institutions like the hudson institute dealing with the perception of the threat, not only in terms of congress, but in terms of the civic society.

my question to you is what for example to media, the role of the media is to deal with the particular challenge, not only in terms of weapons of mass destruction but the cyberthreat and some other threats and the questions of priorities in terms of understanding what is really the top priority to deal with this issue and what congress can do. >> got you. if someone can tell me how the media works. i am a new member of the media for about 60 days. i would like to know. these are hard and complicated issues and it's very hard to fit into a 152nd or 302nd sound bite. i don't care if you're talking cyberor bio defense. remember when the cloud got

violated and people had very personal intimate pictures had to be hollywood stars, and that got people's attention mainly because they wanted to see the stars they like to unfortunately. but how do you have the conversation about what happened, what allowed them to crack into the cloud come again into a secure server is still something people want to cap friday. we never had the conversation publicly. i found it difficult to get people interested because it's not reagan your face. it's not right there. this train station attack scary stuff took the lives of real people commuting to work everyday. the kind of activity we know they are interested in. the vulnerabilities in this country and larger cities about how you would react to something that bad.

it is just really hard because it isn't something exactly happening here. we had a very difficult time getting their attention when i was chairman on the impact of chemical weapons and exactly what that meant when they were starting to use the stop files and what does stop titles were and what was available for them to use. i thought that was an discussion to have. we never really had that discussion. it was really hard to get it out. that is a terrible answer only because i'm not sure i know the answer. i do think you have to keep at it. the best way you can make an impact is if you make an impact with members of congress and policymakers in the executive branch, that starts on a wave of its own. when people interest and fix the problem that is how you get there. legislators come executive branch professionals all of those people saying we agree this is a problem and we need to

do something about it. that's a long process. the media can play a part in that. i hope they do. it's hard to have conversations in the media today. >> we want to thank you on behalf of the panel and the hudson is good of which you are a fellow. thank you for extraordinary public service. you are very thoughtful, refreshing and candid assessment of these issues and i guess it's a fellow at the institute, we may be back as we pull the report together to make sure we get the details right in areas we talked about today. i can't thank you enough. >> thank you for public service to thank you for having me today. when i said the media wasn't? getting it right, i didn't mean cnn. they are exactly getting it right. wink wink. [laughter] i just want to make sure they still let me in the building later today. >> thank you very much.

[applause] >> ladies and gentlemen, we will begin now with the response and recovery session. we are going to have five panels today. we've got a lot tucked into a five and a half hour time. so we are grateful for your patience and more importantly for your participation. we will talk about the pre-event activities, public health response pharmaceutical response recovery and mitigation and finally we will take a look at some advice of people with regard to leadership in the public and private sector rest of relates to the efforts of the panel. we invite the first panel to come to the front. i will make the introductions brief. please join us. pre-event activities and emergency response. keith brand, fire chief oklahoma city fire department is president and chairman of the international association of fire chiefs.

dr. matthew henson seeing her visor for health affairs and texas a&m university. dr. carter meets her, senior advisor office of public health department of veteran affairs. former director for medical preparedness policy, homeland security council national security staff. for both president bush and president obama. gentlemen, the introductions could be a lot longer. we thank you for your contribution and service this morning. chief, we'll start with you. >> thank you, governor ridge. it is an honor for me to be here this morning and i appreciate the short introduction. that is just fine with me. as the president and chairman of the board of the international association of fire chiefs, i represent over 11,000 leaders of the nations rescued service and it is on their behalf this morning i am honored to be here to speak to you about the

response issues relating to the threat of terrorism using chemical -- >> everyone here in the back? make sure the microphone is working. people in the back having a difficult time. >> as you stated in your opening remarks another previous speaker just mentioned also, the threat of terrorism using biological agents or chemical agents in the u.s. is very real. we have seen several examples over the years of biological agents such as an rx in rice and beans and insert new band concert at the availability of industrial chemicals that are out there in society today represent also a very real threat at modestly different levels of vulnerability in various communities across the country. according to be a spirit

transportation transportation statistics, u.s. census bureau 2007 commodity flow survey 2.2 billion times corresponding to 323 billion-ton miles of hazardous materials are shipped by air, road, rail and pipelined in the united states annually. obviously hazardous chemicals are a vital component to the american economy and quality of life. we must realize extremist take advantage of weak essays in the nation's transportation system or chemical facilities to obtain toxic chemicals for nefarious purposes. we see these things in media reports and on though shall media that there are pro- jihadist groups, transfixed, isil, that our tweeting. they published a document known as the explosives course which teaches interested parties to use commercially available

chemicals to manufacture explosives. the threat is very real and something we have been prepared for. in terms of response to a terrorist attack, as far as the emergency medical services are concerned, it would be treated as any accidental material and once the release of the nation is concerned, the fire department in the area would isolate the area involved, stabilize the area to minimize civilian exposure to that agent. establish safe zones to make sure we limit the spread of the agent to unaffected areas. many cities like my city in oklahoma city would deploy hazardous materials response team. in other areas that may be somewhat more of a regional response team that would be in place. that seems to be deployed to use

chemical detection technology to ascertain the type of agent of the salon with personnel trained in the signs and symptoms of chemical and biological agents and their affect on people. the hazmat teams and other specialized contractors to be in charge of decontaminating the scene. we absolutely would be reliant on local law enforcement to play a huge role in seen security and begin the investigative activity associated with the event once the incident is identified as a terrorist attack. during the response depending on the nature and complexity of it the local joint terrorism task force and others say federal authorities including national guard units would be alerted and brought in to assist. if the attack involved a chemical weapon, support teams may be required to help with the response. it would also be very important in this type of incident to

prevent further panic in the area. emergency responders would have to be very cognizant of vigilant about the threat of a secondary device. an important difference between an accidental hazard material and chemical terrorist attack is the necessity of working with federal, state and local law enforcement agencies to preserve evidence and maintain seen security for the criminal investigation. a little bit more complex situation might involve an infectious disease such as smallpox and in that event, the public health community would play a larger role in working with us to manage that incident. it would be important to track down who was exposed to the disease and who came in contact with these patients in this type of event, this is where you see symptoms they not be present or may not arise immediately, but in the doing days.

although each of these agents are chemical involved, might have their own intricacies. there are some commonalities within response to a chemical or biological attack. firstly accurate information is one of the most aspect of that. one of the goals of a terrorist attack is to cause public panic. it is important accurate information about the incident he related to the public in responding agencies to eliminate as much panic and eliminate as much confusion as possible. obviously in the age of social media and initially there will be a rush of inaccurate information and it will be a comment on authorities make sure they track that process that properly for the reason of trying to get as much accurate information as possible so we can keep panic down to a

minimum. during the recent ebola situation here in the country fire fighters depended on their leadership to provide accurate information about ebola symptoms what precautions you take when teaching possible ebola victims and what steps they should take to prevent them from exposing the families at home. another response to the chemical or biological attack would be a coordinated incident command structure be put in place. fire, emergency medical services, law enforcement emergency management would coordinate after including public health as they mentioned and possibly military national guard unit. the national incident management system is designed to provide the capability for federal state and local partners to work and operate together. again, during the recent ebola

scare us there were questions of which organizations would serve as commander in some cases decisions were made outside the command system and not just tends to cause a little more confusion than is necessary. another component -- >> nims has been designed across the board to be deployed regionally and nationally, i hate to interrupt here but you've got a jurisdiction to deal with response and recovery effort continues to perplex me. what was the harper? >> again, when you bring in the public health community that ordinarily might not be involved in an emergency, especially the media stage is of an emergency type of incident. again, when you deal with something such as ebola if they haven't been used to it used to

it and you haven't been exercising the saturday program in a training environment, every component of that or everybody that might begin to manage the incident by not be used to operating that type of structure. >> appreciate that. i won't interrupt again. >> another important component of the responses training. it is absolutely essential that local firsters ponders trading for acts of terrorism including chemical or biological incident regular basis. these events are low-frequency but very high risk which means there will be a few actual veterans of these types of responses. again from the ebola situation we learn firefighters have a better confidence and responsive leadership they have adequate information, high-quality training and protective equipment. as an example there a number of

youtube videos about how to remove the equipment after an ebola patient which would be dangerously incorrect and misleading. obviously, availability and having the necessary equipment as they lead into what is essential with first responders of adequate amounts to respond to these types of attacks. the national association of fire chiefs recommend fire department theo to stabilize the situation for 72 hours before federal assistance arrives. one of our concerns from recent events as we found there was a six to eight week backorder of the personal protective equipment necessary for ebola responses. in terms of preparedness for a chemical or biological attack, a few recommendations for ensuring effectiveness would be one that the federal government must provide accurate in town the threat information to local

first responders considering the multitude of potential threat and certainly we still see budgetary constraints of local government, local first responders need to know which drives they should prepare for. if groups promote violent extremism and publishing training materials on the internet or social media, the federal government should provide information about what tactics and techniques are being taught in order for the local entities and agencies to be prepared. the local joint terrorism task force or fusion centers are working to build strong relationships with local law enforcement to help local fire to obtain the information. >> chief i will tell you why. i know you've got lengthy testimony. i would like you to submit it as part of the record in who would be pleased to review it. i think your colleagues have

statements to review as well. we would like is submitted as part of the record. if you would be kind enough to conclude and if there's anything you want to add this is an important panel and i would like to give the advisory board a chance to interact with you. >> i will just wrap up by saying is important for federal local agencies to plan, exercise using chemical or biological agents. the private her has a big role to play with the governmental agencies both a local state and federal level and a vital component. the apartment again some agencies that exist out there to provide them with the training. i can't stress enough the

collaboration that needs to take place from all levels of government from the local level on up to be prepared for these type of incidents. thank you for allowing me to be here. but it got to answer the questions. >> we are grateful for your participation. i've got a couple questions for my colleagues. >> again i am the senior adviser for engineering extension service at texas a&m university. i also have a private-sector practice of occupational and environmental medicine and that may be germane to some of the comments i have. i have been asked to speak specifically. i am going to speak more specifically to the health care system that may be associated with that. the first thing i will say most of the settings the first request is actually advocacy for additional funding.

i will focus away from that although i would say they can use the resources. i will also offer the absent come adequate and appropriate strategies for those resources money that is missed and to the point of folly and it's very important that we look at the issues taking place are chemically in the health care system and how that might affect what we do with the strategies. on that point i will give a quick address to send issues we know. health care systems are in general competition. they are businesses and we expect them to somehow uniform and seamlessly integrate during an adverse event. this will be especially arduous but things like them pictures of these scenarios are bio defense issues. coalescence of health care is important to understand how it came to be. health care systems are corporations and in that capacity they grow like other corporations either organically by having practices unaccomplished in the

marketplace or by acquisition in which case the acquisition may be a bit distressed company that is vulnerable to assimilate procedures and policies or they acquire a successful entity that is doing things well and thus resistant to taking new policies. in any case we see the situations allow for some integration between platforms and software those become vulnerabilities when we talk about events such as the fire disaster. when we say why did the electronic medical record transition are wider than the fact is that may be why. that is to be understood in advance of the preparedness activities. in her a resource has done more to adjust platform. that is different than what we regard as massive stockpiling and warehousing capabilities. good for business, not so good for disasters.

many government programs have addressed this with regard to resourcing of strategic stockpiles and things of that nature. the chief illustrate about what we talked about the pb issue that about the pb issue that there is no doubt some vulnerabilities when you to talk about with these things. i want to talk about the human resource issue because that's important as well. one of the major breakdowns of human error or human issue is to be understood and anticipated sometimes. understanding the way that health care workers are going to integrate in the system now and how it is changing its instrumental in preparing appropriately. one can think as recently as 10 to 15 years ago that the position of the health care system is there an independent contractor. they were an advocate for the patient, but then they had a different leveraging position with the health care system. nurses traditionally were employees of the health care

system. the paradigm is inverted now where we see in many cases nurses are part of a group that practices embarks on an agency basis. physicians more and more status out of the labor statistics analysis where the anticipation is that 75% of physicians may well be employees. that changes the concept and the compensation reward mechanisms with the groups. this is important. this is an economic, organic reality that needs to be understood. similarly speaking. i like the background music. that's wonderful. >> sorry. >> no, that's perfectly fine. there was an issue of ebola and then are seen involved the numbers stood out when they asked nurses for familiarity are having read the disaster for the contingency plan for the hospital 8% of knowledge they had. that is a disturbing number.

that was reported to the media. whether that's accurate or not. but it does belie an issue. some of those things with the way they integrate speak to that. i have been trained and have been taught almost to a punitive extreme than not supposed to bring problems to the table without offering solutions, so i will try and do that now. what you really need to do is think about what we do in terms of training with regard to the personnel. the way to do that i believe and there's been discussion to look at this in terms of an old military cause further duties explained. if you are on the ship in the peel potatoes, you also have a battle station during a good time the health care cohort might well be served by.and there are mechanisms to have been for paramedics or mps. they were stirred -- state

certifying agencies that go out and do the job they are going to do. they're a state boards of medical examiners or state medical boards and nursing boards similarly. where those are different if you live from the organization to board certifications as we talk about license issues and that is instrumental to people being able to function. those are excellent mechanisms. in many states, there've been analyses done. university of maryland did some analyses with the nurse practitioner provisions in their statutes. it was interesting but cannot because there are dissimilarities, but a greater number of similarities. to understand how a compulsion if you will terms of renewal might include some preparedness mechanism may be valuable in that hasn't been fully explored. similarly with physicians, we see more and more specific cme is called and i think that what

not. this might also be a piece taken on and i would engage the community to advise on matt and get a better return on the absurd. i mention the board. i would also offer hospitals and health care systems proper, there's been a great deal of discussion of how we would engage in a chair and health care coalitions of sars approaches are concerned should be undertaken. i do support that. health care coalitions are large, monstrous animals in terms of what they entail. many different equities come in many supervisory mechanisms. you are talking about an entire community with the health care system. it's valuable, the most successful in the broadest taking. so it will add new challenges. hospitals and health care entities, we saw during ebola and understudy state considerations with a variety of types of pathologies trauma

burns, heart attacks cardiac care and strokes, we see stratification within health care systems at different hospitals being leveled this versus level data and how patients are transferred or handled. it doesn't make sense but apart from that with bio defense or something like that. ebola illustrated guide and we ended up ultimately the centers for ebola care within understanding hospitals would then feed those patients if someone presented to the emergency department. this is where some organization like the joint commission would be valuable. they've undertaken this with other specific types of health care considerations or specialties. i think i would be a great area for additional consideration to take place. the joint commission is wonderful way they execute this. they could be a valuable service in helping to bolster the insensible aspects of the health care system.

i am out of breath and i think i've exhausted attention. i will yield the floor to my colleague at this point. >> thank you. >> good morning and thank you for the opportunity to address the panel. i would like to focus the remarks by recent example of one of the more typical scenarios the wide area release. this scenario illustrates many challenges we face in preparing for and responding to violent threats. white area anthrax poses complexities generally not seen in a typical hazardous materials believes. clearly definable contaminated areas would not be known, may be spread over a large area. because contamination levels throughout the affected area cannot be known with precision i've run across a broad geographical area must be assumed at risk and as a result responders need to assume all people in the area in the order 7 million most major college in areas the antimicrobial postexposure plexus.

i would like to have a few issues for consideration. although we tend to focus on the public health and medical consequences of a large-scale biological attack it would be much more than a public health emergency. it'd be a national security crisis. by definition this would not be a naturally occurring disease outbreak and would not behave as such. this is the work of thinking, plotting and reacting enemy and the enemy would combine multiple violations, engineer the violation to be resistant to countermeasures for you to use conventional weapons to attack secondary targets of opportunity such as large crowds of people gathered together a point of dispensing. due to the delay of more than 24 hours to recognize a covert attack with our bio detection capabilities, consider the domestic and international travel into and out of our major u.s. cities in that 24 hour period from the moment of attack to the moment of recognition.

by the time an attack is recognized and individuals who may have been exposed to be scattered across the country and in fact across the globe. moreover, attack anywhere with heightened concerns for major metro areas everywhere due to the concern of reloaded secondary attacks. an event may be international in scope by the time it's even recognize. second immediate response of dispensing countermeasures to the population of the major metro area in the opening hours is critical to prevent loss of life. challenges associated with the times associated with the times and contest are significant. in the event of an anthrax attack, oral animatics need to be started in 40 hours of exposure to minimize illness and end of prophylactic antibiotics are effective only if given before illness or symptoms occur. because there's an inherent delay with existing detection

systems, responders like we have far less than 48 hours to complete the task. third, little can be done after the initial period to make up or recover from a failure to provide a postexposure prophylaxis. the response including federal government assistance must be immediate and cannot fail. that is why preparedness and response efforts have been so frontloaded focusing on this immediate mission, the rapid distribution and dispensing of countermeasures. the challenge they face is how to assist cities within the narrow time window and if i response is not fast enough, life hangs in the balance. they're not the most pressing challenges we face. one rapid detection identification of the bio threat appeared to come immediate coordination of an olive government, all of nation respond. immediate access to life-saving medications and vaccines and maintenance of public safety and security without which the distribution of dispensing of

life-saving medications would be impossible. given these challenges, the expectation in local jurisdiction is on a sound for the first 48 hours during a disaster does not apply. the immediate challenges have been described as the four d's to simplify the challenge we face. detect comedy side, distribute and defend. improving detection comment form in an accelerating decision-making that would be chaotic and confusing are critical to mobilize a timely and effective response to minimize the loss of life. this all presumes that capability to detect an attack. by detection and bio surveillance activities enemies to activities enemies according to mobilize an olive government response to help maintain public safety and security and assist at the distribution of countermeasures and three the adequate supplies of countermeasures available to the first place. i will focus on the second and third and fourth. others have addressed the issues

of surveillance and buyer protection in the importance of recognizing a bio attack. in terms of the second e. decision-making, the federal government has protocols for coordinating all of government response and other rapidly evolving threats such as maritime and aviation threats. in 2011 the federal government established an analogous protocol for wanting to bio threats. the biological assessment and response for batter. the purpose was to respond to it by a thread by enhancing a situational enhancement and more effectively direct the resources of federal government with immediate response. as important a process -- i understand the acronym has changed over time. it's regularly exercise and import triggers for activating the process include scenarios for uncertainty and ambiguity and indecision might delay

recognition and response to a bio threat. the last two, distribute and offense are the most daunting. we face the challenge bounded by the physics of reality. how quickly can we mobilize and distribute and dispense antibiotics. how can we mobilize federal personnel and asset to assist with maintaining public safety and security as well as countermeasure distribution and unseen. i will quickly mention what strategy. one strategy for mobilizing federal personnel and assets is to make a difference to leverage the assets in place working in or near the impacted cities. what agency with expertise in distribution is the postal service. the postal service is the second-largest federal agency in the federal government with approximately 600,000 employees. one out of every four employees were for the u.s. postal service. and they are present in all

communities across the united states. six days each week they exercise a capability for every household and business in the united states. the potential advantages of leveraging the postal service capability to deliver animatics are readily apparent. in 2009, the president signed executive order 12357 for establishing capability for the countermeasures following a biological attack. the postal model was singled out and mentioned in the executive order. postal service and five other federal agencies dod ba homeland security department of justice and health and human services account for three fourths of the civilian federal work force and encompass key capabilities needed including security and public safety logistics and delivery and public health and medical care. work still needs to be done to integrate up in a capability until local response plan to mobilize assets to take time during event to minimize delays potential responders want to

have immediate access to countermeasures for themselves and families. the executive order called for establishing a mechanism for the provision of countermeasures to ensure functions of federal agencies could continue. the key component of a postal model could be achieved for the responders for workplace for the issuance of home assistance. this all underscores the importance of reducing time to detect an attack to mobilize response and distribute and dispense countermeasures. it also highlights to be flexible and prepared for surprise because the incident and was once may not unfold as expected. given how difficult it is to quantify a bio attack and quantifies investment in the face of many competing priorities facing federal state and local governments as well as budget realities, we must look for the most efficient cost-effective and sustainable threat that will protect americans and safeguard our nation against the threat. thank you again for this

opportunity. >> thank you both very, very much. let me start if i could. chief one of the areas that emergency responders have depending on the state are the mutual aid capabilities, what they don't necessarily build up the capability within every fire station or community to respond to every conceivable challenge but within that region is talked about regionalization. doc tears minson you talked about regionalization. as you take a look at the resources and the jurisdictions of the chief how effective is the mutual aid concept in terms of gaining support nationally to respond to the variety of challenges at either the physical act of terrorism or the

biological chemical attack. we know everybody likes to have all the equipment, all the toys albeit crude treatments they need to be specialists. how effective is the tool and how embracing is the broader fire chief community in accepting the fact that they can't have it all, but they better regionalized their ability to respond and recover? ..

and again, if there is an incident, they are all brought to bear in a collective manner. beyond that, you mentioned the mutual aid. i think that's something that has been a big part of the fire service community throughout the towns, cities and so forth would hold resources that time. and oklahoma we are no stranger to natural disasters so to be part of our response and the two are mutually partners are, and we exercise of those things on a regular basis. and again we've had a lot of experience in dealing with that. so i see that as a fire chief as something that's improved over time. again, some of the programs of the federal government post-9/11 has established particularly the program has been very instrumental in bringing, and pulling those resources we don't have to have each community

equipped with the exact same things but the resources are there in the region and we know where they are and we know how to pool those when necessary. >> dr. mecher, to your point you talked about centers for ebola care and once again is are similar to mutual aid kind of idea but you do create a center of excellence. what is the is very compelling authority, what is the initiative needed for the broader health care community which as you point out is very very competitive very competitive, so that individual hospitals and health care delivery systems will give up to a certain extent surrender their autonomy to a particular hospital or health care system to develop that level of expertise because often that means there will be funding it going to that center of expertise which every hospital ceo would like to have in his or her jurisdiction.

is there enforcing mechanism that could require that, or who decided to basically, these would be the centers for ebola care? >> so i put their the carrot -- i prefer the carrot to the stick in a situation like that. i think compulsion of behavior is probably going to be less effective. i mentioned when we did stratification of health care under joint commission considerations. there are advantages. there's marketplace competitive edge. there's sometimes deeming mechanisms that helps with things like medicare presentation. it enhances the competence in the committee that you have a hospital or health care facility that's capable of rendering a certain type of care. i think that those are the elements that will actually help. i think eventually i would say that if there were priorities or a funding stream or cooperative agreement, that it was a

designation that facilities that have demonstrated that had a certain type of capability would have an advantage to some of those funding initiatives. that sort would be an inducement. i think it would be useful. not every hospital is going to be able to do the same thing. that's just reasonable and that's to be expected. as i said, we recognize this and a lot of different pathologies and disease processes. stroke, a classic example. we have the joint commission where they have sort of descriptors for a primary stroke center versus a comprehensive stroke center. they require both some equipment, some training some exercising all the things one would want with a biodefense initiative they have that for stroke capability. and so i think the templates are out there. i think the mechanisms that make those things successful in a steady state of the same mechanisms we will want to follow if we were going to design this for biodefense initiative. i won't delve into i could be

are all the talk about the particulars of it but i think there are some pieces to that we want to exploit ever if we wanted this to be successful if that makes sense. >> it does. >> just for the occasion and help illustrate this my background actually pretty does he was as a local preparedness director, state director prepared in maryland and it strategic medical officer health and human services. in the portfolio were countermeasures first responder protection asia and the national security strategy. what the chief was taught but as far as i think other princely several public health agreement also see what we see with regard to hospital prepared as fun as well. i think patterns are there. i think they're successful. i do want to point out vulnerable is not be there has been success because it is important to acknowledge that they are there. but i think one thing that comes to mind for me is urban search

and rescue. nativities able to do that. we have these regional collectives that often are called it a point either by states or by the federal government if there's been a disaster. that's the notion of a good example of what might work. >> chief, 20 years ago oklahoma city had a terrible tragedy, the bombing of the federal office building. what have you learned since then and what kind of trade, if that had a bioterrorism aspect would come into didn't know at the time what it was what's the difference between the training of your people now and what happened 20 years ago? >> i think anytime you have an event like that, and again not only the bombing of 20 years ago but as i pointed out we have very regular natural disasters. you learn lessons and learn what

works well and what don't. i was in terms of the bombing before the was in nam smart national management system that was in every case a nims event. because of the agencies involved in the federal building obviously. as the doctor mentioned that was our first experience using the urban search and rescue teams that are sponsored by thematic throughout the country. we just 13 that were deployed during that event. -- enough. we recognize in a coma city that we weren't as skilled and has equipped an urban search and rescue as far as building collapse, those types of tactical risks comes to that event that we need to be. that is certainly, since then and since we've developed our own program in oklahoma city that we collectively work with tulsa, tulsa metro area for urban search and rescue in the

state, that we become more proficient at that which has help us again, some of the ensuing natural disasters that we've had to respond to overtime. so i think just with every event is lessons learned from lessons to be shared. had the oklahoma city bombing had a bio, i think i'm a little bit scared to think about at that time because just doesn't mention terms of tactical russia i don't know that we would've been as prepared for such components as a bio agent. >> you brought a few new people and for search and rescue. i like a lot of employees. i was at hhs at the time. >> yes ma'am. >> dr. mecher speed i'm dr. minson. this is dr. mecher. >> dr. minson, almost every hospital in this country has to do with infectious diseases. so you really, if we're talking about certain centers and we're talking about highly infectious

diseases like ebola. because we can't afford a health system in which we don't have a reporting system, state health departments and to the cdc so we can follow patterns this congestion with infectious diseases every day. could you talk a little about that infrastructure? i want to be careful that we are not thinking that all infectious diseases go to these small numbers of centers because we are really we are doing with this every day without knowing whether it's a bioterrorism outbreak but with a system that looks at patterns. >> thank you. that's a very good point. so to elaborate on that i think you're stating absolute correctly. what we are not suggesting in this discussion is that anything different would be created. simply what we are saying is sort of what happened during the

ebola response in this country was that we had facilities that have both expertise matériel equipment, and, frankly, the wherewithal to take care of the disease as it went through the arc of the disease. with an expectation that any hospital should be able to recognize it report it to stabilization procedures control it and ultimately been if the issue was something that had specialization requirements that there might be referred on to a center of excellence or send a special, however you want to describe it. i do want to use the trauma analogy but i'm going to. the truth is host hospitals in the united states, you can't control who comes through the door. we have laws that prevent that, rightly so. but if an individual were to present at a certain type of traumatic problem at the hospital didn't have too, say a search or the anesthesiology

support or critical care support, that individual because of our arrangements and relationships that already established would be able to transfer that individual after -- >> after they stabilize them. >> absolutely. that works very well. that's what i'm saying is we should not create something different. they still have the same requirement for reporting of the trauma, statistics and whatnot. it's the same thing. it's just looking at it in terms of our defenses specifically some of these more esoteric type responses. >> i wanted to ask a question about the post office department to an extent of the post office department. last time i remember that implementing anything it was medicare. i don't remember them having refrigerators and other than to keep the lunches in. wouldn't we be better off using the pharmacy network in the united states for the ditch addition of vaccines or anything

else. we've got a system, private sector but it's pretty well organized and i would think that if i wanted to get some things out fast bringing in -- the contract if remember, the federal government contract are not with the post office department but a with fedex and ups to bring in pallets of drugs. i would dispute them to an existing network of pharmacies. and i assume that was looked at as well. there are more pharmacies in this country than the our post offices. these days. so i would think we would use an existing system that has a control mechanism rather than rebuilding one for a distribution system. >> i would agree. i think we want use any and all capabilities to be able to rapidly distribute countermeasures. there may be particular scenarios where that may be more attractive. for example pandemics. pandemic influenza, where you

want perhaps you want to be a district antiviral medication very quickly. that's not a bio attack scenario, and you leverage your pharmacies to be able to distribute those medications. if we're talking about a bio attack, one of the challenges you have a when you look at distribution points is making security and all those challenges. it's slightly different. in terms of distribute countermeasures come if you think about what order of magnitude challenge you would have, if you need to distribute to 5 million people in 24 hour period, you try to count to 1 million, takes you about 12 days. 1 million seconds equals 12 days. 5 million seconds equals two months. that's a big 5 million is. you could have multiple channels that you can distribute it to but it underscores really a challenge you face in a very short period of time. very rapidly distribute countermeasures to a population

where you don't know what's happening next. this isn't a naturally occurring disease, and it's reminiscent. i put into washington, d.c. on the morning of 9/11 right around 8:15 p.m. came into reagan and headed to the headquarters for a meeting. what struck me about 9/11 which i will never forget was uncertainty was going to happen next. during that initial 12 hour period it was very uncertain. so i could put myself in a setting of a bio attack come and in the midst of that event very early on and not knowing what's coming next. and what of the second to attacks might there be. and i would think security would be a critical issue. so the challenge is, is being able to balance the you said all those other dissertation point that you potential have yet also maintain safety and security for the public. >> thank you. thanks very much for your remarks, gentlemen. carter, great to see again. chief, other like to direct this

to you. i know your comments about the amount of intelligence briefing that you received from the federal government, you and others in the first responder community, and that's been a challenge just concerned about getting what is generally classified information out to the first responders so you can make use of it. and, obviously, particularly critical for use it can inform how you're going to prepare for an attack it looks like it's more likely that our adversaries could use chemical use a chemical threat, prepare one way. if it's a bio threat a particular bio threat, to prepare another way. it's critical that happen. i know with the police local police, they have more regularized intelligence briefing processed in part because they are part of the infrastructure that's going out and doing the investigating on the front end. my question to you is from the perspective of somebody who's a

non-police forces talk to me become in terms of you all and the public officials, are you getting the intelligence briefing that you think you need about what our adversaries are looking at so that you can actually sort of position yourself and be poised respond to what is the threat of the day as opposed to what might've been the threat of the briefing he got a year before? >> i think it's both. in some places that happens in a better way and more often than in other places, to be very frank. i think a lot of it depends on the area you are in. as a nation, if there's a joint terrorism task force in your area, the non-law-enforcement first responder community may be more of us involved in that. if you have a fusion center that gathers and disseminates intelligence information, in my case one of my deputy chiefs sits in a fusion center, and so he is briefed regularly.

i think there are gaps though. in other places we don't have a good relationship that there may not have been relationships established between the fire service emergency medical service and those law enforcement agencies that they don't get as regular and as in depth briefings as they should. so there's some work to be done there, but i think overall we see some improvement. i think it's somewhat incumbent upon us in the fire service to keep pushing in that regard to make sure that we do get the information that we need sometimes that what it's takes. -- that's what it takes. it boils down to communication issue, boils down to a trust issue. i know in some cases when you're talking in terms of the federal government and those federal agencies, that collect and disseminate intelligence, you know, there's a security cleared issues that come into play. i don't know that we need to know the detailed information on my side of the fence but we at

least know there's a threat out there, the potential of the threat, the credibility of the threat so that we can be prepared. so over all i see some improvement in that regard but still some work to be done. >> not surprised at all maybe it's uneven around the country. it's based on relationships, based on a sort of what tradition you have any particular region, et cetera, of coordination among the different agencies and first responders. but looks like you are well-positioned as chairman of the national association of fire chiefs. maybe the polls of your colleagues to stand with the weaknesses and strengths are and push for it. and also to let us know because that intelligence process indication that intelligence gets out deal to prepare for that's part of our few. so any input you have on that would be helpful. thank you. >> we've heard several others talk about go from i need to know basis to any to share basis, and we just need you and

the chiefs chiefs and the others not in law enforcement to keep pushing and developing that need to share culture. and relying simply on relationships within regions is a good start but it's not where we need to be. it's not the finish line that we want to see developed if, indeed, there is to be an integration of the federal state and local levels. we appreciate your candor on the. advisory board, questions? multiple questions. go ahead. >> first of all other like to endorse secretary shall and his comments about using the private sector for distribution because i think it's a good idea and i know there's been some companies of this tradition networks have talked about and have been they've received some assistance from within hhs i think it's something we should look at in the report. for dr. mecher, you're one of the few people who serve on homeland security council and then into the new incarnation when it became the national security staff. i was one if you talk but whether the lead to any diminution of capabilities or was it a seamless transition to homeland security

responsibilities within the security staff? and also you see this home and sigir function within the white house getting in within the four d's view discussed? >> when i was at in windows homeland security council under president bush dr. robert cadillac was the senior director of biodefense and asserted within during his tenure at hse. i had the opportunity to see a senior director in place the primary responsibilities for deal with biodefense. it was an identified individual who had primary responsibility to lead the biodefense effort. following the transition and the reorganization of homeland security council into the national security staff, that office was subsumed into a directory of resiliency. so that senior director position was removed at all of the portfolios that were social with

those individuals and biodefense removed under resiliency. if you recall the early in the administration we were hit with h1n1. the work that i was involved in an others and biodefense was in pandemic prepared as an pandemic planning development of the national pandemic plan, and so when h1n1 began in april, or late april of 2009 it was early and just settlements into the administration. and so we did not have a senior director in biodefense and what was organized was a response with leadership within the office of resiliency to lead the effort or organize interagency effort for h1n1 which is really a major buyout effort. the number of us were really involved. what it did see was the difference between having a leadership that was identifiable for biodefense and then not having a single individual who

really you could identify as biodefense. i think there are some advantages. i saw them firsthand in the past administration of that individual and leading the effort which bob cadillac certainly did. >> do you think we should return to the did having a separate council? >> i was talking about the advantages of having someone identifiable, senior individual to lead the effort in biodefense. i think the homeland security effort still could be certainly lead from within a national security staff. it still was come homeland efforts were still identified within the national security staff. what was missing was an identified senior official for biodefense. >> so i'd like to ask the panelists about their respective committees responses to the ebola outbreak over the last six months or so.

we have wrote of the few proxies for biotech in the sketch. darpa distinction between people and the kinds of things that quarter was just discussing but do you think we did better or worse than you would've anticipated? is there anything that surprise you we can learn from that we can think about in terms of preparing for biological threats? >> would you like to go first? [laughter] >> who wants to go first? >> this speaks to the coordination problem. [laughter] >> i will give an anecdote from the corporate sector. we are a multinational. we have people that were in western africa at the time performing things for infrastructure support. we worked with government partners. we initiated a quick indication campaign. we do look at how we're going to move summit if we had someone that was ill which is not a

private concern. it's one that has to the coordination between the private sector and the government accepting the individual coming back for care. what i would say is i think it was regional to say that across the board what we saw was mixed results. and that's there. i think if i were going to say if there's anything i would look at in terms of changing because i think that was the root of your question i think i've already offered it. that is this idea of having, if you will some sort of system for identification and and communication and the and communication and the need to build the referral of the individual to the proper facility that can take care of them, their bradley. bradley. i think we are better conditioned to do that now because we been through this and we made some mistakes and we've done some things well. what happened like to see is that rather than do this every single time disease specific us up like to start to do this with an idea of infectious disease or biodefense rather than wait to

got to go to the reiteration with the peculiarities or esoteric nature of each of the different agents. i think that's the safest, smartest way to do this. that may not be in place right now and i think that's something we can start to attend. that's my thought. >> two comments. one, being able to convey the risk, and i think a reaction to a highly, infectious disease with a high consequence infectious disease with a high rate communicated itself to i think we did see the spike in fear. the challenge i saw was really to be able to conceptualize what that risk truly is in terms of trying to quantify that risk. but that risk is always viewed through the lens of other, the outrage factor that the public views that risk within. so i think risky communication it's always a challenge any kind

of event. to get to the issue that i think matt was mentioning i think we focus a lot on where to treat these individuals and what really was needed was the assessment capability. does anyone really need to have the capability to treat ebola are managed ebola patient, or do they need the ability or the capability to be able to quickly recognize it, recognize simple things that they can do to protect themselves and other staff and other patients and very quickly get the patient to a specific center rather than try to set up centers and where potentially to take care of these patients? that i saw was there's tension between development is capable of across the country versus focusing the capability and the relatively small number of centers and expanding the capability, just like the infectious disease. you have that capability edward to take your patience with infectious disease but you have

a concert at capability to actually manage the high consequence infectious disease as. so i think that is a distinctive between assessment and where we would provide the treatment in the city where we can protect our step it the other thing that i think that we can realize is that the patients are their most infectious when they are the most bill when they are critically ill. we put these patients in intensive care units which we staff with, are very intensive in terms of personnel. so in terms of controlling the disease outbreak were almost doing the opposite thing. we are exposing potential large numbers of people who are highly lethal infectious disease at the very moment when those patients are probably the most infectious and have the highest viral loads. i think what the event also underscored was thinking about icu medicine to my background is in critical care so thinking a icu medicine and the special need you have in icu care which

we tend to throw lots of resources and lots of people yet when you think about ebola these diseases, you're almost were in the opposite direction. you are trying to constrain the number of people of contact limit the staff or having contact with the patient. somewhat opposite of a we normally do in critical care medicine. >> that's what isolating the space is important. >> a question for carter and perhaps met. similar to the previous question, but carter, your testimony really highlighted the need, we forward talked about how novel bio threat is a low probability high consequences and its demands to novel approaches. and it requires people thinking outside of their box and outside of their comfort zone, and it requires cultural change.

and the postal model home stockpiles and yet the private sector needs to be incorporated in this in novel approaches. but it's really speaks to leadership. so it comes back to leadership and it is also maybe not -- having the secretary and deputy sectors also engaged is very, very important as well. and that leadership we've are because you believe having a bobcat like and that leadership in the white house is important. what are the lessons learned since you're in either hurting so to speak in the white house in addition to just having that position what other attributes need to be attached to the position to be most effective? >> there's a consensus you would like to call him bob kadlec. we can't do that.

put him in their spots in the administration. would be truly coordinated but absent that we're looking for other alternatives. >> in terms of leadership i think one of the things the leadership provides is i had the good fortune or the opportunity to be able to watch transition and administrations to see what happens as administrations change. i also was able to see firsthand h1n1, deepwater horizon, the haiti earthquake, fukushima. and got to see firsthand how what it feels like when a disaster unfolds. and you watch it stutter, and unfolded while it was unfolding we would have conversations some of us in biodefense and say, it's 24 hours past the point which is thing we first heard about this event. has this been a pirated event? we would've been pretty much antibiotic distribution and