i hope we answered some of your questions and we will see what happens in the coming days. thank you so much. [applause]

>> coming up tonight on c-span, a discussion on u.s. preparedness for a biological or chemical disaster. then the parents of james foley a freelance reporter killed by isis discussed their efforts to free their son. later, help homeland security care on the role of the federal government in protecting cyberspace. the blue-ribbon study panel on bio defense held a meeting on preparedness, response and recovery from biological threats. this panel features dr. erwin redletter. he is a professor of health policy and management at columbia university. he expressed deep concerns with the u.s. preparedness to deal with threats. his remarks are one hour.

>> thank you for accommodating our request to keep everything on schedule. we still have quite a bit of ground to cover. i'm grateful for your willingness to help us keep the schedule. our election is -- luncheon is dr. erwin redletter. many of you know him as the professor of health policy and management at columbia university. he is also director of the national center for disaster preparedness. we will invite erwin to share his thoughts with us. a pleasure of working with erwin since my days in the white house. dr. redlener, please get us the benefit of your thinking. if you would, please. i expect you can be prepared to get quite a few questions from the panel. dr. redlener: looking forward to

it. thank you very much. i appreciate the opportunity to be here. i have known many people in this room for quite some time. we have been through a lot of issues and struggles to gather -- together and it is i feel a privilege to speak to all of you on the blue ribbon studies panel. i am going to try to keep my remarks pointed and specific as i can. part of the introduction may be should have been, i am a person with a half empty glass instead of half full. full disclosure. i just want to forewarn. i want to say there are many issues to explore as we think about disaster readiness in the united states. not that most americans thought much about this issue before that beautiful sunny day in 2001 when america was attacked by terrorists on the very day, as it turns out, was new york city

mayoral primary election that did not happen. clearly, mostly but not entirely unexpected attacks with great loss of life and dramatic infrastructure discussion was -- destruction was shocking enough for all of us. and why wouldn't we be shocked ? we are a country isolated from a certain level of turmoil and threats are more prevalent than other continent and other nations other than our own. we were observers from afar. until that day. yes, we had the oklahoma city bombing by a home-grown terrorists, but this kind of extremist violence by evildoers from other countries just didn't happen here. to me, there was another aspect of the 9/11 attacks that i can -- someday in consciously or not to our collective disbelief and shock. the actual complexity, logistics, the coordination, the precision of the unimaginable scenario three simultaneous jumbo jet hijackings was very

much in the realm of a pretty mediocre bruce willis movie. but it wasn't, of course. it was a real, honest to god wildly imaginative terrorist attack that shook the nation and the world. we could have learned and applied a lot of lessons from that attack and the anthrax that soon followed. in my view unfortunately, we had experiences that did not turn into real lessons and lessons that did not change policies or the way we prepared for subsequent events. sadly enough, that is true for most of the disasters we have experienced in the 14 years since 9/11. experiences without lessons, lessons about applications. we have made progress and some of it ok. but we are nowhere near where it should be. we should know for certain will be protectively referred to as wake-up calls have been far more suggestive of alarm clocks with

very accessible snooze buttons. the catastrophe happens. there is intense drama and media coverage followed by promises to prepare or respond better the next time. but when the cameras leave, we hit the snooze button and drift back into complacency, not changing as much as we should have. that is human nature on some level. of all the lessons not really learned about disasters since 9/11 from how to respond for a , major anthrax attack, prepare for a super storm or breakdown the most important thing we fail to do was to learn to think about disaster readiness with sufficient imagination and an appropriate scale. it's not that improvements haven't been made. indeed, some important progress has been made, like making airplane caught its -- cockpits impenetrable. despite of the horrible german wings tragedy last month, in balance i think we did the right

thing and we did it pretty well. but have we learned how to accelerate recovery from a major storm like katrina and the golf, -- in the gulf which 10 years , later is still ongoing. what about this no-space of recovery from the 2012th superstore and sandy in the northeast, still far from completed. articles in today's paper about delays in funding and how people get out of the jam they have been in since that storm. radio and communication technology challenges contribute to the deaths of hundreds of responders in the world trade center attack in 2001. in 2015, 14 years later, responders including firefighters rushing to a serious smoke condition in the d.c. metro system couldn't communique -- communicate from the tunnel the units on the surface. really couldn't communicate. and while some might disagree, i am telling you we are hardly better, in my opinion, if at all to respond to a major pandemic

then we were in 2006 and 2007, when worries peaked about a possible avian flu that could replicate a global disaster like the spanish flu of 1918. even though we spoke volumes of planning binders in terms of what we needed to do, i don't think you could show me a large american city that has prepared and sustained a public health systems such a calamity. not a single city in the united states. even worse, if you could find the article he prepared health -- adequately prepared health systems, no plans more than scratch the surface about how we could assure the pipelines and supply chains for food and water needs in a massive epidemic or how we get the vaccines or prepare antibiotics made at scale and distributed properly and in a timely way. or how we analyze, or what do we know about the enormous impact of pandemic of this size would

have on the economy, locally and nationally, maybe globally? what are those impacts? how are we going to cope with those? who is planning to deal with them. here these are the things i worry about, which is one of the reasons i have a limited social life and why my wife doesn't let me talk about my work at home. [laughter] that said, i do want to talk about the things i would consider among the more important barriers to the united states being better prepared than we currently are. not in any particular order, but all in my mind important fact yours. -- factors. the list for the purpose of my remarks this afternoon does not include the gross underfunding of the public-health system and other essential systems to needed -- needed to improve resilience and i think he discussed this at some length already today. about funding, i want to make one point. we can't really define what we mean by prepared.

how can we expect to find something that we cannot define? what do we actually mean by a prepared city or state or even a prepared hospital? we simply don't know the answer to that. if you could attend hospitals, you'll get 10 answers. 10 cities will give you 12 answers. i would daresay i do this when i speak about this topic. i will not do it here because we just are going to do it. normally i would ask you to raise your hand in this room if you feel with respect to yourself, your family, your pets, your community, how many of you actually, raise your hand invisibly. how many of you actually feel prepared for a major disaster in your community? how many? i'm telling you i've spoken to , all kinds of audiences. if i get more than two or three hands up, and then i test them. who is taking care of your mom

in the nursing home? who picks up the kids from school of? what do you do about important papers, how are you taking care of your mortgage? what is happening as we get into the details, it is abundantly clear to me that we don't even know what we mean by prepared individuals. we can call the red cross perfume of guidelines. -- red cross or fema guidelines. that is hardly enough to deal. >> we are glad you didn't answer -- ask the question here. good job. dr. redlener: out of kindness and respect. i am just saying that if you can't define it, how can you find it. in a sense, we're definitionally challenged and that is a big problem. let's put that aside and say that is lingering out there and something that at some level we have to deal with. i will give you the five top concerns, or five of my top concerns. first is unfortunately the federalist system that we live under in the united states. in many ways the system serves our country and its people very well.

the point is that decisions affecting the lives of citizens are to the extent possible decentralized and by design, government decisions are made by levels of government as close as possible to the people being served. that is the point. if a fundamental tenet of our society and on the whole it is good. the problem is it doesn't work for disaster planning. federalism and disaster planning are essentially incompatible. because federalism doesn't allow us to create an enforceable coordinated master plan to -- or even the ability to ensure specific regions are prepared for disasters, which are particularly likely and specific to their own communities. why does the state of alabama require every school to have a safe shelter for the kids and staff, and oklahoma doesn't? why? is a tornado less likely to kill

school true to in oklahoma and alabama? how and why is that tolerable? what about terrorists that nation of an improvised nuclear device? not a dirty bomb, but an ind. why is there no city in the united states, no city, prepared for such an event, even though people in the federal government say that new york city, chicago, washington, houston, san francisco, l.a. are all potential terrorist ind targets. yes, it is improbable, but something that is on somebody's book of business to think about. why does the mayor get to decide that it isn't a priority? maybe the are correct in that decision, but maybe not. this is part and parcel of the reality of the system which we live. the second problem i mentioned is what i am calling the denominator problem. i think this is rampant throughout government. let's say experts in a state say that 100 million or 200 million

are needed in the event of a major pandemic. the governor announces that the state has a million masks in the emergency stockpile, and in hospitals, five or 6 million. we are patting ourselves on the back. except, they are talking about the numerator. i want to know the denominator what they need. this is a problem rampant at every level of government. when you hear a report from an official at the local health department, here is what we are doing to prepare for this disaster. the mayor should be saying but what do we need on the path to get where we need to be, what more is that going to take? we cannot be satisfied within a -- with a numerator answer to a denominator question. the third problem is what i refer to as the authority

conundrum, and the problem we have in managing disaster decision-making from the disaster communication plans to implementation of any effective. five years ago the bp gulf oil spill became one of the greatest oil related disasters in history. so who was in charge of the response? and the capping of the deep water well? the care of the affected communities. the president assigned to the coast guard commander and the federal agency of the united states under the president. is that who was in charge? was the governor of louisiana in charge? how about bp itself? how about billy nungesser, the plaquemines parish president at the time? a lot of people have a lot to say. if there was somebody fully in charge of that response, i would be glad to know it but it wasn't actually a parent -- apparent to me. a year later after the disaster and catastrophic failure of the nuclear power plant, who was in

charge? again, impossible to determine who was in charge. that is the problem. from the message into the strategies to stop the damage, this is a question and these are questions never properly answered. and if it were answered or some entity was in charge, it was a closely held secret. if that there was a very large scale emergency that requires all health and public health hands on deck in new york city who would call the shots? command center but who makes the final decision? the mayor, the governor, the health department of the city? some years ago the true story of a ceo of one of the largest systems in new york city said to me that in terms i will not use here because i don't know all

of you as well as i could [laughter] but let me paraphrase what he said it was i don't care who tells me to evacuate the hospital, i'm in charge and responsible for the life and safety and i report to the board of directors of my private voluntary health system. i do not report to the mayor or governor or the president for that matter so unless it was a major national emergency declared, i will decide what i'm going to evacuate my patients and i will also decide which hospitals i will send them, and when and how. so he perceived himself as being the sole independent responsible party. in some ways, the system says, you are right. we don't control that. when we do planning on the health system readiness in new york city we have people getting -- potpourri of people and things and entities, pleading with people to try to get together and plan what we are going to do for a big disaster. by the way after ebola these

hospitals controlled by whatever entities are going to want reimbursement for expenses they incurred getting ready for the disaster or as a result of the disaster. the bill that came into the nearly $5 billion fund that was appropriated by congress were just out of control. there were millions of dollars for hospitals that said since we have to get ready we should spend this amount of money and not only have we lost revenue because we didn't admit patients to the 10 best reallocated. so things are out of control. fourth problem. something i call dangerous disconnect. three examples. the first i was worried about was the disconnect between the silos of public health and personal health services. so, between the disasters, the daily function of state and local public departments are fairly routine most of the time

, providing all types of community services and surveillance creating policies towards the goal of improving public health. childhood vaccinations to restaurant inspections and the like. many have disaster planning as well but therefore the health -- and they are for the health department. in new york city, the health department does not plan for the 75 private-sector hospitals. it talks to them and interact with them, but does not plan for them. on the other side on the other , silo is the massive direct health services system from the doctor's offices and clinics to enormous academic medical centers and systems, caring for patients teaching new generations of health professionals into supporting medical research and all that's fine. it's fine except when it comes to planning or responding to disasters.

in circumstances of crisis, they must function as interrogated coordinated -- integrated coordinated systems of assessment direct care public safety and prevention. decisions about hospital allocation of scarce resources and a myriad of functions blur the line between the public's well-being and the health of individual patients. right now we lack the resources and in most places the planning authority to integrate these two systems when it counts and in a big disaster that is a major problem. second disconnect, military and civil and civilian assets. take the example of an evacuation. let's say a hypothetical elected mayor of a town of 65,000 people previously a prominent business leader, and with great campaign, he is elected. he appoints a number of commissioners with a wide range of experiences, some relevant others not so much.

now comes a disaster. state resources but now the city was caught in the publishing of 60 to 70,000 people need to evacuate quickly. the emergency plan is put together and here we go, greenlight. wait, how is this going to work? who has the food supply, the water, the medical care, not only because they have chronic medical conditions but somebody will have a heart attack were seizure en route. who is dealing with that in organizing the traffic patterns and making sure there are diapers because the babies to -- because traffic will be slow? where is the fuel coming from and who will deal with motor vehicle accident and where are these people going by the way? is the national guard being deployed and who decides what they are doing and how they are coordinating with local resources? shouldn't they be coordinating with local resources?

we didn't see that after sandy. think about this. shouldn't the regular military forces of the united states be in charge of large operations like this? because, who are one knows logistics and people moving better than the u.s. military ? why are they not running the show on the circumstances i just described? where were they in the planning process so they were known and fully coordinated assets while we are planning and not ad hoc while it is happening? we need to fix this. that is a big barrier but it needs to be rethought in the age of the mega disasters, completely rethought. the final example is the private sector which is deeply unsettling for people. 85% of the infrastructure in the

u.s. is owned by companies and individuals in the private sector. but the government is in control of the regional planning disasters. i talk about a couple of examples where confusion in the gulf and japan was very apparent. when the new york state ready commission was convened by governor andrew cuomo in the aftermath of hurricane sandy, we were charged to examine what happened and asked to recommend what should happen in future disasters to avoid or mitigate some of the more vexing problems created by the storm. for instance, the prolonged electrical problems or gas shortage crisis. the governor wanted to know what the state should do to avoid similar crisis in the next storm. we concluded their first up steps could be taken for instance the fuel reserve stockpile in the strategic locations around the state. millions and millions of gallons are used every day, so there is a limit to that. that would not be enough to really have a functioning system

to make sure we didn't have that crisis. but it's the private sector that owns the oil wells and refineries and the delivery trucks and those are the key , factors in making the supply chain during the disaster. like it or not, they are part of the solution. it's not just because they own the assets they also have the , experience and expertise in a lot of brainpower not just lipservice but we need them at the planning tables every single time we do serious disaster planning. we need wal-mart and ups and fedex helping us in the distribution systems. there is much more we could talk about about this but i want to wrap this up and i do want to say, i could have talked to you

now and at some point i would like to about other issues for example the issues of the vulnerable populations which have been marginalized in essence the most disaster planning. the administrator of fema actually is in the camp that i applaud, which he understands all understands full rubble -- vulnerable populations have to be part of the central planning as we are going if we are going to have an effective plan. it's necessary. i don't think people understand how many of vulnerable people there are. let's say we have 310 million people, 75 million are children, 45 million are senior citizens an hundred 20 million have some kind of chronic illness. 22 million have some kind of disability. 44 million are poor. a million in nursing homes. they are not just out there ready to be taped onto a generic

disaster plan. they are the disaster plan. if we can't take care of those people, the plan is useless. it's dysfunctional. it is not even moral. we have to focus on this and we haven't been today. i want to end with a thought and i would say i guess the fact as -- get the fact that as wealthy as the united it, and we have unprecedented wealth even now then on the -- any other point compared to other countries, but our resources are not unlimited. and the possibilities for the devastating disasters that could affect us are literally staggering to the imagination. and we have many of the -- other priorities. so i am not saying, spend a bank. we have all kinds of disparities in the country. we have $3.5 trillion in infrastructure repairs that need to get done. we have cancer and alzheimer's

disease did here and many of the , schools are in big trouble. while my plane was canceled this morning, i got to read the entire "usa today," 61,000 bridges in the united states called in bad shape. 61,000 bridges. it's not the tunnels or the levy. it's just the bridges, ladies and gentlemen. so, here's the final point i'm making here that i understand we have to make decisions and establish priorities. but what really troubles me is how those decisions are made. they are made passively, and -- in actively they are made by , default. we don't have the grown up the -- grown up dialogue that we need to conduct a mature society should have examined the need about how and when and where we will spend our treasure.

because if we did that and went through that process and then we all decided that we simply are not going to prepare for every capacity that we are going to spend the next decade fixing the schools and education systems or fix the infrastructure to make sure every kid has appropriate access to quality healthcare fine. we've made a decision in the best interest of the country by everybody joining in and arriving at that decision. the problem is that the process for the decision-making is a mess. it's not proactive, it's chaotic. it ineffective, decision by default and bad knowledge experience and as such it has predictable outcomes. it's literally random-access preparedness as we have across the united states. and in my opinion, the situation is not something any of us should tolerate or be proud of. that's all i have to say. [laughter] >> next time that you appear you could be more provocative, ok. [laughter]

i wouldn't expect any less of you. thank you very much. i think i will turn to the advisory panel. ladies first. >> i would like kathy to reflect on one particular vulnerable population. -- ask you to reflect on one particular vulnerable population. that is children. especially children and bio defense. could you talk a little bit about the special populations, the vulnerable populations in particular children in consideration. dr. redlener: children represent a particular poignant challenge for us. i'm a pediatrician by background.

i have five grandchildren. representative rogers: i am very tuned into children and have been for my whole career. it was immediately apparent that no thought whatsoever had it been given to the special needs of children and this came up two weeks after 9/11, i was at a briefing of all the hospitals in new york city with federal state and local officials talking about the two weeks later. it was cute and a, i was sitting next to someone at columbia and i said, what is being done around the planning for children who might get caught up in the disaster and literally the panel looked at each other and one of them said, nothing. that is when i went back to my own institution and made calls

into the american pediatrics and a process was begun by probably 20 or 30 pediatricians from different places and different places for children then began to really look at this and eventually the national commission on children was born. from that, a bunch of recommendations have come from that. i would say that most of the relevant federal agencies have been really looking at what the needs of children are. the problem is we don't know a lot of the answers. we don't know that those -- what it is for kids who are exposed to anthrax, we do not know it. so, we bring in the experts at consensus conferences and we ask what is your consensus about getting a call in the middle of an eye, if there is a situation, what are you going to say?

so, there are things happening. but we are far from a place that i am comfortable with. newark city schools with a million schoolchildren, i am very worried about the level of fairness in the schools, very worried. -- level of preparedness in the schools, very worried. we have a lot of work to do, but i would say in this case that the process has started. >> can i ask you -- >> alexander and then dr. parker. >> with the questions that you have raised, and they are legitimate. i am looking at history, what worked and it were, for example the experience of noah and the

ark, in other words in the face of the coming flood, what did noah do? no time for hesitation, time for a decision, that is the story. what is the moral? how can we learn from that kind of experience? representative rogers: i think the big point, dr. alexander, is that we went from no to bind disability insurance. it is a mindset that i think adults generally come to, that if we can just kind of way around and not do anything for

the future, invest in retirement, or by insurance, we can keep rolling along and something happens, then we are really sorry that we didn't do any thing. guess building -- i guess the building an ark. or what you do with your personal life, that is another example. and that is a decision, and especially for individuals and companies where there are economic decisions to be made, we need to come to a process that allows us to say, we are going to build an ark, we are going to prepare these cities for the event of a nuclear deck of -- nuclear detonation. it is a decision that we get to buy discussion, discussing science and the facts and discussing what we want to take risks around and make sure that we are invested to reduce risk. i get where you are coming from. that is what i would say about it. >> dr. parker.

>> yes, i want to thank you because you have galvanized the preparedness community and officials, helping vulnerable populations, particularly children. thank you for that. the question i have is along the lines of the unique challenges with the defense and particularly the medical countermeasures, antibiotics in the step out vaccines that are licensed or in development. and you would know that the community has taken a serious grapple with the challenge of how do we really make progress now and how we collect the data that is needed -- so how do we make progress that we have the right and a biotics and stockpile and the dosages for children, how do we get these vaccines that can be available for children? representative rogers: i am glad that you brought this up.

i think particularly around the farm industry and public health, we are a little bit the drift. the farmers are operating under the business model that isn't necessarily compatible with what the country needs from a public health point of view. the country is missing -- i wrote about it in my book, the surgeon general told me that the country is missing a public health czar. i think you get the point, somebody or something that could lead the development of ideas. these ideas that would be level to take the reality of trying to

have a functional business where again the ceo does not report to the secretary, that person -- wait a minute, or anytime actually. the problem is that we have different worldviews of what needs to happen and unless somebody is going to put up the money and a substantial -- and a substantial way that there is an understandable business model, we are dealing with incompatible systems right now and we do need some way of finding a common table that smart people from the industry and the public health committee can say listen, we have tried different things, but now we really do have to solve this. the policy for example, with

superbugs, who is going to develop those antibiotics and at what cost >> -- i will cost? what is that model exactly? i do not know what the answer is i am just agreeing with you that this is an important point. >> it is interesting to hear you talk about a denominator problem. you said that your cup is half full. [laughter] >> it is not. i actually don't even have a cup. >> seriously, though, i have two questions really. how do you prepare for an improvised nuclear device attack and to what extent, if at all, is washington dc and its environment, has there been any planning? >> this is an interesting

question, this is an improbable event with the enormous cost glances. what researchers have shown us is that it is a very interesting reality, that if the public knew some very simple things about sheltering and places from 30-48 hours and then leaving upon getting the right instruction from public officials, hundreds of thousands of lives could be saved in a place like new york city. if we only did that -- but if you are the mayor of new york city, are you feeling like you want to go warn people about when hiroshima occurs in time square. there are communication issues but what is frustrating that fact alone, if every citizen new it, it could be beneficial in saving lives. secondly, there is mythology about it.

a lot of people would be killed, there would be horrible destruction, but not everybody would die. we would have maybe 75,000 deaths in a city of millions, it would be a tragedy, but it would need for people to be organized and taken care of. if we are putting our head in the sand and not talking about it at all, then it we are guaranteeing that if it did happen, we would have the worst possible outcome as opposed to a better outcome. >> has any such planning a kurd in the washington -- occurred in a the washington environment? >> i am not the national security council, the secretary, there are things that are being discussed on a high level that are complex and top-secret.

so, if it is being discussed in washington dc behind closed doors, and it does not get to the cities and to the citizens we have a problem. nobody -- where does the message get connected from the people that are interested in the continuously -- continually of government, for example, how many people in your office building? i asked -- on the seventh floor, asked him where his staff was? he said, she is out to lunch. there are things happening obviously, there are smart people at the highest reaches of government discussing these things, but if you do not let us know in the cities and states

and counties, something else unbelievable to me, that if you model patterns out of a large city where people are going to go, let's say we had a meltdown in the power plant, 18.7 million people that live within 50 miles. so millions of people are not coming back, where they going to go? people in the communities that are not coming back in their lifetimes, there is a single town, village, county of united states of america that hasn't been appropriately planning for receiving, because it isn't just bottles of water, health care, schools etc. i am not aware of any planning for destination communities for

large-scale evacuations. or for displacements. a lot of areas that require a lot of work. a issues. not for the faint of heart. >> what are you doing in homeland security? [laughter] >> if you have trouble going into washington dc going in on a sunny day, how will you get out if it is a bad day, it is not going to happen. you can't take that notion and say ok to your point. you will have huge panic, anxiety, you have to have something in place. you need duct tape. [laughter] i think you raise a very important question, the environment, the urban environment poses complex

problems because it is there where we would see a massive evacuation. you can get out of the outer banks when the weather channel says it is coming your way. technically i don't know why you lose -- leave buses in the parking lot when hurricane katrina is coming, but with an unexpected event, i don't think you are evacuating big cities. i think you have to accept that as part of the planning procedure. so the answer is, nothing about evacuation -- it ain't going to happen. [laughter] >> dr., i am intrigued about your comments about the decision-making process for preparedness and allocation of resources. according to, you find a disjointed and one response to that is that this is a messy process and things are allocated

by criteria that may not always be rational. that is the reality of democracy. that is the reality of testing of the responsibility of political executive branches. you mentioned in terms of how to fix it, and rationalizing the democracy. use adjusted a public health czar or official, any other specific ideas on the federal level on how we can make that process a bit more rational going forward >> -- going forward? representative rogers: i would start at the top. i think the president and his staff, the cabinet, have to come to some agreement about a structure for the decision-making that becomes increasingly more inclusive and gets down to the government. it gets down to real decision-making. i know that there are meetings

for example the deputy secretaries of the deputy secretaries of various issues, they go back to their agencies and you know something happens or doesn't happen. but, even the attempts to bring people together right now tend to dissipate rapidly. so i think that sustained leadership from the top is key. secondly, right now the reason i am talking about this public health czar, is that there is no particular venue within government as it is currently structured and there could be. it is not compatible with democracy to have a forum that has authority and the ability to change things, to be the place where these things are discussed. i do not think that it is beyond humans to figure out how to reconcile the needs of our very vibrant, important industry of

farmers with the public health needs of the country. we needed someone to convene that and guide that. i know a lot of people in the farm industry, because for a lot of reasons, and i don't think that anyone would refuse to participate in those discussions. we need to have somebody leading it, where they come to the table and knowing that they are -- what they are saying and concluding will have impact and consequence, as opposed to another meeting where you come in and talk and go back to business as usual. that is the cycle that needs to be broken. i really would not be distressed if the decision was taken. you know what, i am just using this as an example, we're not going to deal with ind's now because it up -- because it is important for new york city.

the new york city average and schools for third graders, at a reading level, is around 15%. i mean we have extraordinary problems. so somebody said we are going to take our chances from al qaeda and we are going to fix the schools, you know, i might not agree with it, but there would be some rational -- rationale for us leaving -- leading to that conclusion. but there would be -- you would know more than me about how to make that really operational. >> if i could follow up on that, that person, who would that be? representative rogers: somebody in the white house. it seems to me, the president needs to say, we need to solve this.

we -- it is in america's interest that we transcend the political differences and figure out how to make a public health and for structure that will help the whole country. i don't know that anyone can say that with enough force or power other than the president of the united states. >> i think it is more complex than that. i guess having a public health czar that would just drive me crazy. another czar without any staff. the problem here is you are talking about different decision-making structures for different incidences. in fact, the fema director commands the public health service in an emergency. the fema director takes over in an emergency they have the authority to do that.

hhs really pushes authority to the director and the public health officers in fact work under the director, particularly in an incident kind of situation. so, there are structures within the federal government to deal with that kind of thing. bioterrorism particularly since it is going to be ongoing, it requires a different kind of decision-making structure. start out by talking about the challenge of federalism. assuming that we cannot get rid of federalism. the question and how do you design a decision-making system with enough authority in an emergency to be able to run the course and be able to manage the various levels of government and the expertise of the united states, and how do you train

them well enough as they go through exercises? if you ask me what happens in my community, i can answer all of your questions. i can answer about the university of miami, the county, but in general, because of someone like craig, florida is organized for hurricanes. not particularly for bioterrorism. but we are organized for hurricanes. we have seven days of them, and all sorts of structures because we are in a coastal region and we know exactly what we are going to do with 10,000 students if we have to evacuate them. but with bioterrorism and the kind of thing that we are talking about, it requires a different structure because you have to have a public health infrastructure, but more than a public health infrastructure, the private sector must be

welded together with the public sector. so, what we need to do is think about how you glued the system together and then let it through a series of exercises, so it actually works. so that everybody knows what they are doing. the fact that nurses we heard have not read the disaster plan is a disaster in itself. the challenge it seems, for high officials, is to figure out how to put federalism together in a way in which it works to be able to manage our way through what are much more complicated crises in my judgment than the kind of bombing or terrorism assaults on buildings, as horrible as they are. i don't think that that is a czar, i think it requires a more infrastructure them back, in terms of who has authority to make decisions. representative rogers: you are

right about that, but right now i think -- i am using the idea of a czar to symbolically express -- >> there is this management at the hhs. representative rogers: right. my understanding is in new york, 2012, the city was flooded with people. the president said we will not have a repeat of katrina, so that every organization being -- even in the office of emergency management. mayor decided he is going to manage everything, so all questions went to the mayor and meanwhile we have people

literally roaming the streets looking for where they are going to set up shop. i walk into a shelter in a school in staten island and they tell me there is a medical clinic. who is operating at -- it? it is doctors without borders. what are they doing here? it was all of these random things and we -- where do we go ? we never really got a satisfactory answer, trying to sort this out. >> that's what happens during most event, they tell people to stay out. the first rule is don't let a lot of people in. representative rogers: hard to stop. >> dr. mckinney from chicago talked about coordinating

activity at the local and state level and unfortunately i don't think that that is a model that hasn't been used very effectively and other communities. at the end of the day, unless you've got everybody at the table, a small group of people at the table and then you exercise and rehearse those plans, you will end up in the same situation as you did post sandy. we have experience with those lessons. with katrina, there were lessons, but most of those were lost and not applied with sandy. so the rudimentary notion of that after each disaster you have a debrief, what has transpired, what was effective not effective, and you maintain observations from that. but we are not doing that in an efficient way so that is an observation that you made that is most important. >> i took your point about the

decision-making process to be directed, not so much at the way we operate in a crisis, but before the crisis, the government possibility to look ahead, prioritize it one threat over another, one value over another, you said education versus preparing for bioterrorism. that, i thought that was what you were primarily trying to address with your comments about the process and your recommendation for a public health official, as opposed to coming up with a decision-making process that operates best in the crisis. am i wrong about that? representative rogers: not necessarily. there are multiple layers. we have problems in the decision-making process, but also way down on the totem pole. just on the planning on the local level. i have a lot of planning meetings now.

you know, we have never found the private sector people there. we are lucky if we get the local red cross chief there. the idea of having those people from the private sector, we need them badly. we will call walmart to bring a truck and bring bottles of water, but the whole process of deciding what to do and how to do it, it is just not right, from top to bottom. the last thing i wasn't saying what you are referring to, at a fundamental level we are not making those decisions and democracy is messy, i understand that, but you cannot have poor disaster planning and horrible schools and broken infrastructure. something is not good here because we have to figure out what we are going to -- we have idea of money, we need to figure out what we will spend it on.

and we have smart people from both parties. >> less caution. >> -- last question. >> you talked about the need for military to be a part of this. and you referenced going back to 1878 or something. have you actually thought through how the congress might rewrite that statute? i would imagine the black helicopters would go crazy if congress started -- representative rogers: right after hurricane andrew, the category five that really devastated south florida, i was there days later and colin powell wasn't running the show. i may have overstated that, but for all intensive purposes, he was a by the president to go down there and it was

phenomenal. it was a very different from what we saw in katrina or after sandy. it was organized, effective, it got done, people were served and it was a big mess, but it seems to work. -- it seemed to work. it was designed to keep the army from being police officers in america. that is the essence. we cannot have the federal government becoming the local cops or state police or whatever. that fundamental principle under the alexander law and it is good, but it needs to be extended to really an arm possible link -- an arms length or the military when we really need them. we do not have the national

guard represented at the majority of these tabletops and when the thing happens, that is a little too late. >> you know, we could keep you hear a lot longer, but we have three more panels to do. thank you very much and we look for to hearing from you. [applause] >> wednesday and democratic senator of new jersey was indicted on 14 federal corruption charges. they stem from a two-year investigation into the center possible dealings with a florida ophthalmologist. the senator allegedly accepted gifts and campaign contributions in exchange for using his office to assist the doctor, who was also indicted today. any statement this evening senator menendez professed his innocence. he has pledged to