Prepared Statement Before the House Committee on Government Reform, Subcommittee on Government Efficiency, Financial Management, and Intergovernmental Relations

Amy E. Smithson, Ph.D. Director, Chemical and Biological Weapons
Henry L. Stimson Center

"Mr. Chairman, members of the committee, allow me to thank you not only for the invitation to appear here today, but for asking several of the key questions that Congress and the Executive Branch must consider if this nation is to achieve heightened preparedness to cope with the aftermath of a terrorist attack. My guidelines from the committee indicated I should address the following questions:

* How are the federal, state, and local levels of government interacting on the terrorism preparedness issue?
* Where are there plans/programs in place?
* Where do vulnerabilities exist?
* How well are the various levels working together?
* How is the federal government supporting local efforts?
* Where is the federal government in the way?
* What can Congress do to improve things?
* What can the Executive Branch do?
* How can the new Office of Homeland Security be most effective?

Should Washington's policy makers not listen closely to the answers to these questions, I am concerned that they will spend taxpayer dollars unwisely in ways that make little preparedness difference.

My answers to these questions amplify the voices of front-line public safety and health officials from 33 cities in 25 states that I interviewed from February 1999 to September 2000. Since the publication of the report that resulted from these interviews, titled Ataxia: The Chemical and Biological Terrorism Threat and the US Response, my co-author Leslie-Anne Levy and I continue to interact with front-line officials from these and other cities on an almost daily basis. These individuals draw upon their lengthy experience in responding to all manner of emergencies and disasters for a series of practical recommendations about how federal preparedness programs can be improved. In all candor---and these rescuers rarely mince words---front-line responders are dismayed at the disarray of the federal government's preparedness programs. Any time the subject of federal leadership of terrorism preparedness programs was broached, the local officials gave eerily similar replies, which can be paraphrased as: "They've been at this for five years and they still can't figure out who is in charge." I was told time and time again that "all the federal agencies constantly preach at us about everybody working together at the local level, but it doesn't take a rocket scientist to see they are fighting with each other tooth and nail over the money and missions."

The Case that Started the Hyperbole
Despite what you might have heard over the last couple of weeks, there are meaningful technical hurdles that stand between this nation's citizens and the ability of terrorist groups to engage in mass casualty attacks with chemical and biological agents. The technical obstacles are so high that even terrorists that have had a wealth of time, money, and technical skill, as well as a determination to acquire and use these weapons, have fallen short of their mark. Chapters two and three of Ataxia elaborate on this at quite some length, including a re-examination of the lessons that should be learned from the very terrorist group that got the hyperbole started, Aum Shinrikyo. To summarize, although the results of the cult's 20 March 1995 sarin gas attack were unfortunate enough-12 dead, 54 critically and seriously injured, and several thousand more so frightened that they fled to hospitals-Aum's large corps of scientists hit the technical hurdle that is likely to stymie other groups that attempt to follow in its wayward path. They were unable to figure out how to make their $10 million, state-of-the-art sarin production facility work and therefore were unable to churn out the large quantities of sarin that would be needed to kill thousands. As for Aum's germ weapons program, it was a flop from start to finish because the technical obstacles were so significant.

Preparing for More than Terrorism
Now, the sobering news. This country needs to be better prepared to contend with chemical and biological disasters regardless of whether terrorists ever manage to overcome these technical hurdles, for the following reasons. First, according to 1999 statistics from the Environmental Protection Agency, there are about 850,000 facilities in the United States working with hazardous or extremely hazardous substances. Many of these sites are located in urban areas, and transport of hazardous substances is a routine matter. Every year, over 60,500 accidents and incidents occur at these facilities or during the transport of these chemicals.

In the past decade, about 95 percent of the counties in this nation have experienced this type of emergency. Accordingly, it stands to reason that US rescue crews and hospitals need to be well prepared to contend with chemical casualties. Also, the truth of the matter is that terrorists intent on causing mass casualties with chemicals could contemplate sabotaging one of these facilities rather than wrestling with the more complex warfare agents.

Readiness for a biological disaster is also essential because even if a future disease calamity never arrives courtesy of terrorists, mankind is still in a race against time to develop new medications before the natural mutation of pathogens renders impotent all of those currently on the shelves. For many a year, the nation's most esteemed scientists and public health watchdog organizations have talked of a looming global public health crisis that would plunge medicine back to the pre-antibiotic era. Human development that encroaches further on previously untouched ecosystems is rousing new diseases. Moreover, physicians increasingly find that their arsenal of medications is powerless against old diseases that keep resurfacing. Penicillin is no longer effective against 30 percent of Streptococcus pneumoniae cases, 11 percent of pneumonia cases are also resistant to third generation, cephalosporin antibiotics, and reports have begun to surface of cases that are not susceptible even to the newer fluoroquinolone treatments. Given the crystal clear data on how microbes are ganging up on mankind, the Institute of Medicine, the American Society of Microbiology, the now-defunct Office of Technology Assessment, and the World Health Organization, among other respected bodies, have given virtually identical counsel about the exigency of boosting medical research to counter the twin threats of emerging infectious diseases and antibiotic resistant disease strains. In sum, it is only a matter of time before a strain of influenza as virulent as the one that swept this country in 1918 or some other disease reappears. The nation's public health capabilities and hospitals need to be readied.

Foundations of Preparedness
The bedrocks of chemical and biological disaster preparedness already exist at the local and state levels. Scattered across the country are some 650 city, county, and state hazardous materials (hazmat) response teams composed of specialists who contend on a regular basis with the aforementioned accidents and incidents. Laboratories and personnel at all levels of the nation's public health system would play a critical role in biological disaster response, particularly in the detection and control of an outbreak. Medical personnel, from paramedics to nurses and physicians, are essential for the treatment of both chemical and biological casualties. Law enforcement personnel would be important for security and criminal investigation missions after any such disaster. Finally, emergency management capabilities exist in the country's major cities and at the state level.

Over the last few years, many of those firefighters, police, paramedics, physicians, nurses, emergency managers, and public health officials have become better prepared to handle the specialized demands of a chemical or biological disaster, thanks to the Domestic Preparedness Program initiated in 1996 by Senators Sam Nunn (D-Georgia, ret.), Richard Lugar (R-Indiana), and Pete Domenici (R-New Mexico). This program's initial goal was to enhance unconventional terrorism response capabilities in the country's 120 largest metropolitan areas, through training, equipment, and planning programs.

The backbone of a federal response to a chemical or biological disaster was in place long ago. The Federal Response Plan, which dates to 1992, divvies up key response missions among federal departments and agencies. For example, the branches of government that would be at the forefront of a federal response would be the Federal Emergency Management Agency, the Department of Health and Human Services, and the Federal Bureau of Investigation. The essential role for the federal government to fulfill is mid- and long-term disaster recovery, which is mainly FEMA's bailiwick. In a major disease outbreak, HHS would trigger activation of civilian medical teams and the national pharmaceutical stockpile. In a chemical or biological disaster, some of the Defense Department's chemical decontamination units and medical personnel could be called upon, depending upon the severity of the disaster and the sufficiency of civilian assets at the local, state, and federal level.

Also, recent federal allocations have spurred some critically needed improvements within the nation's public health system, perhaps the most vital player in the case of either a natural or man-made disease outbreak. The object of neglect for decades, the system has benefited from a badly needed infusion of funds that has expanded laboratory capabilities to detect the rarely seen diseases that could be employed if such an outbreak were to occur.

The Need for Federal and Congressional Coordination Yet, as one might expect, there is always room for improvement. According to the survey that I conducted, local public safety and public health personnel in these cities assessed themselves as being more ready to deal with a chemical disaster than with a biological one. Chapter six of Ataxia contains more detail about where the particular problem areas are in each kind of disaster response. Federally, the main challenge is not that more assets need to be built but that federal involvement needs to be coordinated and streamlined. Dozens of federal entities have been fiercely competing for the missions and money associated with unconventional terrorism response, an unfortunate circumstance that has resulted in redundant capabilities, wasteful spending, and, at the local level, confusion as to which agency would spearhead the federal component of a response.

Perhaps it was inevitable that the launch of resource-rich programs with high-profile missions would be accompanied by considerable friction between the federal agencies involved. As the Domestic Preparedness Program training, equipment, and planning efforts unfurled, federal authorities preached the importance of local response agencies working hand-in-hand and claimed that they would do so themselves. Front-line rescuers, however, got the distinct impression that the federal agencies were locked in an intense competition for terrorism preparedness missions and money. Local suspicions of a federal turf battle could be confirmed when the federal partners spoke, as they did at a mid-April 1999 conference. A Pentagon official stated: "We have ramped up tremendously over the last eighteen months. We have new assets, like the [National Guard Civil Support] teams. Some of them make sense and some of them have just been generated through the process." Afterwards, a representative of the Federal Emergency Management Agency added: "We have a fairly small amount of money at stake here. We'd certainly like to have more." Next, an official from HHS chimed in with, "We don't lack for authority. We lack for people and money." Small wonder then, that the locals found the federal "work together" sermon to be hypocritical.

The locals continue to have trouble figuring out who is in charge among the many federal agencies and what the overall federal game plan is. Federal programs have varying time lines, slightly different goals, and conflicting views on priorities and how to accomplish certain response tasks. "The more federal agencies that got in the act, the more confusing it got because they each had their own approach," said a state official who watched the whole circus repeatedly come to town. "They weren't bad people or bad agencies, it was just their view of the world."

The duplication of effort aside, these circumstances created practical problems locally. For example, the federal agencies did not standardize the terminology and content of their courses, which left the locals puzzling over the discrepancies in what they were taught.

Given that monies to combat terrorism have been buckshot across over 40 federal agencies, the pace and size of the expansion of federal programming led inevitably to efforts that not only waste taxpayer dollars but imperil the overall effectiveness of the federal government's programming to prepare for and respond to terrorism. Duplication of effort certainly exists in the plethora of research and development programs that were launched to find new detectors and other response equipment. Had Washington policy makers consulted experienced first responders before throwing money at the problem, they might have realized that these individuals do not need all of the equipment that is being developed in their name. For example, why is fancy, expensive decontamination equipment needed when front-line firefighters quickly recognized that they could configure their ladders and pumpers to create impromptu mass decontamination capacity? Another case in point was the creation of over 90 terrorism response training courses and several specialized training centers. Not only was training abundant, it was redundant. Befuddled local officials could hardly wade through all of the options. Meanwhile, no one in Washington refereed the explosion of courses or provided guidance about their quality.

In no small part, fractured congressional oversight has contributed to the mess at the federal level. Committee jurisdictions relevant to the unconventional terrorism issue range from armed services to government reform, transportation and infrastructure to the judiciary, commerce to veterans affairs. If the federal bureaucracy is to be streamlined and meaningful preparedness is to be achieved, Congress needs to coordinate much more rigorously its oversight activities across committees of jurisdiction and exercise more discipline in the programs it authorizes.

Institutionalization: The Cost-Effective Route to Nationwide Readiness The time-tested and commonsense alternative to the proliferation of training courses is the one that also underpins the all-hazards, echelons-of-response system that both states and cities know and advocate: institutionalization. If preparedness is truly to take hold nationwide on the front lines and be sustained in perpetuity, then it belongs in the local and state training academies, as well as in the nursing and medical schools. A few cities surveyed for Ataxia have already added a course at some or all of their responder academies, but a great many more indicated they had no plans to do so. Yet, institutionalization is the most cost-effective way to spread training geographically and build a tiered response capability.

The prerequisite for institutionalization is standards, and all of the response disciplines-fire, police, EMS, hospital care providers-expressed an abundance of frustration over the absence of standards and protocols to guide them. Standards command the attention of rescue and healthcare personnel because they are the backbone of accountability. Other standards are established at the state level, flowing from the responsibility of governors to ensure public safety. In some disciplines, major professional organizations articulate standards, a role played most strongly by the National Fire Protection Association and to a lesser by the International Association of Chiefs of Police. In the healthcare field, treatment protocols and standards of care evolve gradually through the publication of peer-reviewed journal articles. Eventually, a body such as the Accreditation Council for Graduate Medical Education arbitrates whether a new protocol will be taught in US residency programs. Adding a subject to the curricula of medical and nursing schools takes at least six years. Once standards and protocols are agreed, state academies, universities, and colleges may incorporate them. The National Governors Association could play a key role in seeing that standards are adopted nationwide.

Another benefit of institutionalization is that it would involve an important feature that has been lacking to date in training programs, namely the regular testing of professional knowledge and skills. Moreover, this approach also involves refresher courses that update materials and skills. After graduating from respective professional schools, rescue personnel and healthcare providers are required to take a certain number of continuing education hours each year. First responders also take regular skills tests to remain certified.

Unconventional terrorism preparedness is on the radar screens of several of the above-named organizations. For instance, in 1998, the National Fire Protection Association issued a tentative interim standard on chemical terror attacks for EMS personnel, as well as for hazmat responders. Pre-hospital and hospital treatment protocols are being developed at a sluggish pace. No overarching structure is in place, however, to move any of these organizations or the state governments forward smartly to create and incorporate standards. Given the advantages that institutionalization offers, Washington could best demonstrate its seriousness about nationwide preparedness by bringing together the pertinent organizations in each discipline to lay the groundwork for institutionalization, complete with time lines. The federal government's job is to be the catalyst and convener that prods the tangle of entities involved in institutionalization to articulate and promulgate standards.

Six years after the onset of the domestic preparedness effort, the time has come for Washington to get out of the training business and turn it over to the appropriate organizations that will take preparedness forward more systematically and cost effectively. The hand-off should be concentrated in these organizations and curtailed elsewhere, so that various branches of the federal government, not to mention enterprising universities and contractors, stop churning out training programs at taxpayer expense. Without such reform, ineffective spending will continue at both the federal and local levels and training lacking in standards will be implemented unevenly, in pockets. Specification of standards and institutionalization of training clearly make more sense than that.

Refocusing Domestic Preparedness Efforts
Those who know first-hand the tremendous demands of responding to a disaster have a saying: "All emergencies are local." In a chemical or a conventional terrorist attack, the life-savers are not some federal response team that swoops in from across the country, but the local firefighters, police, paramedics, nurses, and physicians. Terrorist attacks in 1995 and just last month at the Pentagon and in New York City underscore the basic truth of who saves lives when natural or manmade calamity strikes.

In the moments after Aum Shinrikyo's sarin gas attack against the commuters in Tokyo's subway system on 20 March 1995, local transit workers, police, fire, and paramedics came to the aid of people gasping for air, some of whom were in need of quick administration of the nerve agent antidotes that saved their lives. The attack unfolded from 7:46 to 8:01 am. The first patients reached the nearest hospital less than 30 minutes later. The Japanese Self Defense Forces dispatched its special chemical defense units downtown at 10:10am. Although these units were located in the outskirts of Tokyo, the teams, caught in huge traffic jams, did not reach the attack scene until two and a half to roughly five hours later. The victims of the attack had long since been cleared from the scene.

So many survivors from the attacks on the World Trade Center spoke of being knocked to their knees by the force of the blast, of being surrounded by darkness and overcome by a sense of helplessness, and of beginning to succumb to the fumes when all of a sudden they saw a point of light. Then, they heard the voice and they grasped the hand extended to them. That hand belonged to a firefighter, the person who led them out of hell on earth. Even as the fires raged at the top of the twin towers, rescuers from across the Hudson River in New York City's outskirts mobilized and headed to the scene in accordance with pre-agreed plans. The bulk of the federal or state assets were far away in those critical early hours, when sadly far too few were pulled alive from the rubble by New York City's bravest and finest and their mutual aid partners.

These two tales of local heroism in the midst of unthinkable disaster speak loudly to the basic principle that should guide America's domestic preparedness activities. Indeed, that principle was very much in play in the original Domestic Preparedness Program legislation crafted after the events in Tokyo. Somewhere along the way, this effort to train and equip local responders veered way off course. Since the Domestic Preparedness Program began, talk inside the beltway has centered not on improving local response capabilities, but on how to enhance federal roles and capabilities. Accordingly, the federal government and its host of contractors have swallowed most of the domestic preparedness monies. In the year 2000, only $311 million out of the $8.7 billion spent on defense against terrorism went to enhancing the capacities of local emergency personnel to deal with unconventional attacks. If lives are to be saved in the aftermath of disasters, this ratio clearly has to be reversed.

A key part of the problem appears to be the refusal inside the beltway to accept the most appropriate roles for the federal government in a disaster response, mid- and long-term recovery. Instead, the last several years have witnessed a frenzy of enhancing existing chemical and biological response teams or building new ones from scratch. Each of the teams built comes with its own logistical and administrative bureaucracy, an additional drain on resources that could be better invested in front-line readiness where lives can truly be saved. Understanding all too well that unless federal assistance were pre-deployed for a major event the bulk would not arrive at the disaster site until roughly 48 to 72 hours after an incident, state and local personnel have to assume that they would be on their own during the critical hours immediately after an incident. In the Oklahoma City aftermath, the first wave of federal assistance did not roll in until fifteen hours after the bombing. More recently, New York State's National Guard Civil Support Team was activated, but did not reach the site until twelve hours after the twin towers collapsed. Then, the Civil Support Team proceeded to employ detectors to search for the presence of chemical agents or other hazards. What the Guard does not acknowledge in its press release about this deployment is that this task was being taken care of hours earlier by New York City's own Public Health and Environmental departments as well as by US Environmental Protection Agency personnel.

The refrain heard inside the beltway when the National Guard or federal response teams are criticized as redundant and unable to reach the site to accomplish their asserted missions is that enhancing federal response teams does not really cost much-just a few million dollars here and there. Such a rejoinder truly belies the fact that national policy makers have lost perspective on the purposes of the domestic preparedness program. A million dollars may be pocket change in the Pentagon's budget, but it is serious money on the front lines that can make a real preparedness difference. Moreover, a few million poorly spent in several programs adds up to a tidy lump sum. To illustrate the point, 2,333 hospitals or fire stations could be outfitted with basic decontamination capabilities for the cost of standing up one National Guard Civil Support Team. If the total 1999 budget for these National Guard teams had been used in such a fashion, 49,800 local rescue and health facilities could have been armed for mass casualty decontamination, a critical shortcoming in chemical disaster preparedness across the country.

Challenges for the New Office of Homeland Security
The appointment of Governor Tom Ridge as Director of the new Office of Homeland Security would appear to be a constructive step that could put improved coordination and streamlining of the federal response bureaucracy on a fast track. Conceptually, imposing oversight on the unwieldy terrorism bureaucracy makes tremendous sense, particularly given the readiness of Congress to increase terrorism preparedness spending in the aftermath of September 11th. In practice, that task will be extremely difficult, for the federal agencies will vie even harder for their slice of the pie and congressional oversight remains fractured. Governor Ridge will need three things if he is to succeed in reshaping federal efforts in a more constructive directive. First, he will require strong budgetary authority if he is to bring the federal agencies to heel. Second, he will require congressional cooperation. Third, but certainly not the least important, he will need sage advice if he is to help direct taxpayer dollars where they can do the most to improve preparedness nationwide. Governor Ridge's right hand advisor should be an individual with extensive local disaster response and management experience.

Working in tandem, Governor Ridge's office and Congress can assess the sufficiency of existing federal programs and response teams and begin to eliminate redundant and spurious ones. In the interim until an assessment of the sufficiency of existing assets is made, a government-wide moratorium on any new rescue teams and bureaucracies should be declared, with the exception of the enhanced intelligence, law enforcement, and airport security measures that are being contemplated. Governor Ridge should also move forward with the appropriate steps to see that preparedness training is institutionalized in local police and fire academies, as well as in medical and nursing schools nationwide. In addition, in coordination with the Health and Human Services Department, this office should articulate a plan for jump-starting federal efforts devoted to public health and medical community readiness. Such programming should feature regional hospital planning grants and additional tests of disease syndrome surveillance systems, followed by plans to establish such capabilities nationwide. Last, but certainly not least, Governor Ridge needs to work with Congress to develop a plan to sustain preparedness over the long term.

I will conclude with one more essential task to which each individual member of Congress must attend. Since September 11th, I have received numerous calls from offices on both sides of the Hill and both sides of the aisle, asking me to brief them on these issues and to help fashion legislation that would put Representative "X's" or Senator "Z's" stamp on the legislation that is taking shape. While I have responded as quickly as possible to such requests, they are in some way indicative of the problem that Washington faces if it is to craft meaningful, cost-effective preparedness programs.

With all due respect, I would point out that while the attacks of September 11th occurred in New York City and Northern Virginia, they were attacks on this nation as a whole. Those who risked their lives that day to save the lives of others were not thinking about themselves or their future, they were selflessly acting in the interests of others. Put another way: this is no time for pet projects, whether they be to benefit constituents or a particular branch of government. This is not about job employment, it is about saving American lives. The future well-being of each American, I would contend, is equally important.

On behalf of the local public health and safety officials who have shared their experience and common sense views with me, I urge Congress to waste no time in passing legislation that brings the burgeoning federal terrorism preparedness programs and bureaucracies into line and points them in a more constructive, cost-effective direction. The key to domestic preparedness lies not in bigger terrorism budgets and more federal bureaucracy, but in smarter spending that enhances readiness at the local level. Even if terrorists never strike again in this country, such investments would be well worthwhile because they would improve the ability of hometown rescuers to respond to everyday emergencies."