Dr. LUMPKIN. Thank you, Mr. Chairman, members of the committee for the opportunity to be here and speak. Today-actually just yesterday-our agency celebrated our 125th anniversary as an agency. Our agency was created in 1877 in response to a threat of yellow fever. Now, just as then, we are addressing concerns; this time it is man-made epidemics. In 1988, the Institute of Medicine Committee on Public Health stated that the current state of our ability to effect public health action is cause for national concern and for the development of a plan of action for the needed improvements. In the committee's view, we have slackened our public health vigilance nationally and the health of the public is unnecessarily threatened as a result. That report was issued and basically went on the shelf. It was not until the events of September 11th and the following October 4 disclosure of an outbreak of anthrax that we as a Nation began to look and identify that maybe we have major problems in our public health system, which the Institute of Medicine Committee noted some 14 years earlier. As a result, we have had major increases in funding. The $1.1 billion allocated for the public health system is a dramatic shot in the arm, one of the largest increases in public health funding that we have seen, at least in my lifetime and I think perhaps in the history of our public health system. We have taken this task very seriously and we have moved ahead. This funding is crucial to rebuild an eroding infrastructure. It is an infrastructure that has to be rebuilt not only in large areas like Chicago and the metropolitan areas but throughout the State where public health is so important. With this funding at the State level, we are establishing 12 public health regional response planning areas; we are hiring 23 emergency response coordinators for local emergency response planning areas; we are establishing local health department administrative grants for preparedness; we are developing an Illinois National Electronic Disease Surveillance System; we're hiring 22 regional epidemiologists to enhance local regional surveillance capacity at the local level; we are increasing the capacity of three State laboratories by hiring staff and upgrading laboratory systems; we are developing local health department capacity to support the State laboratories and to develop surge capacity; we are establishing a hospital health alert network so that we can communicate in a much faster way with hospitals the way we have already established with local health departments; we are enhancing 24/7 flow of critical health information to public health partners throughout the State at the local level; we are establishing a local health department training and education grant to build capacity; we are facilitating the development of a model regional hospital preparedness plan and providing direct funding to hospitals to implement these; and we are establishing core preparedness standards for the threetiered facility classification system. All these are important enhancements that we are doing with the Federal funding and we could not do them without it. You have before you a little document that I found as we were preparing for our history, the 125th anniversary, and what it is is a document from a page of one of the publications we had in the 1920's and what it says is "A full time medical health officer prevents disease." The interesting thing is that, when you look at this, how he is communicating with his local people by phone is pretty much the way we do things today-telephone and pieces of paper. You see before you this blue card, it is how we get reports about infectious diseases in this State. We are using 1920's technology. With this current round of Federal funding, we are going to be able to move into an electronic system-the first phase will be implemented by October this year-because of the influx of new funding. Our public health system has undergone a period of neglect. I think it is very important to note that, just as someone who is exposed to anthrax is not treated with just one dose of medication but is treated for a number of days, we cannot treat our public health system with a single infusion of funds. We have to make a longterm commitment to continue to fund the enhancements, which we believe in this State we are using wisely to create a system that will not only help if there is an attack, but every single day will help. The enhancements we did in the laboratory enabled us to better respond to West Nile disease. If we are going to rebuild our public health system, we will reap the benefits even if there is no further attack, which unfortunately, we do not believe is the case. Thank you. Mr. HORN. Thank you, Dr. Lumpkin. Next, we have Dr. Pamela Diaz, director, Emergency Preparedness and Infectious Disease Control in the Chicago Department of Public Health. She is accompanied by Dr. John Wilhelm, commissioner, Chicago Department of Public Health and Dr. Arthur B. Schneider, professor of medicine, chief of endocrinology section, University of Illinois and David A. Kraft, director, Nuclear Energy Information Service. So we will just go right down the line, Ms. Diaz. Testimony of John R. Lumpkin, MD, MPH Director of the Illinois Department of Public Health Before the House Committee on Government Reform's Subcommittee on Government Efficiency, Financial Management and Intergovernmental Relations July 2, 2002 My name is John R. Lumpkin, MD, MPH and I am the director of the Illinois Department of Public Health. I would like to welcome you to Illinois. 125 years ago this agency began with a budget $5000 for 2 years and a staff of 3. Times were much simpler then, but the challenges were the same, to protect the people of the state from infectious diseases and other threats to their health. Before I joined the Illinois Department of Public Health, I was trained in and practiced emergency medicine. I have been involved in emergency preparedness and disaster response for almost 25 years. IDPH has taken seriously our responsibilities related to being prepared for natural disasters and other emergencies. This planning took on new meaning in 1993 as we addressed the potential for a major earthquake in the New Madrid fault. It is predicted that such a quake would have an intensity of over 6 on the Richter scale in Southern Illinois. In 1995, staff in IDPH became concerned about the growing potential for bioterrorism and started including training and preparedness as part of system development approach. We established an emergency medical disaster response plan that incorporated the existing Emergency Medical Services Systems and Trauma System networks. Additional resources were identified to assure that medical personnel could be mobilized to respond to an event anywhere in the state. This plan has been used as a prototype for many other states. The Chief of the IDPH Division of Emergency Medical Services, Leslee Stein-Spencer has received national attention for her work. She has served as part of the TOPOFF 2000 evaluation team in Denver, a member of the Executive Session on Bioterrorism at the John F. Kennedy School of Government at Harvard University and has served as a consultant to the Department of Justice. This system was activated on September 11, 2001. Within 2 hours the IDPH command center had status reports on the availability of hospital beds, ICU beds, Emergency Department beds, number of ventilators and monitoring equipment from every hospital in the state. When Governor George Ryan created the Terrorism Taskforce in 2000, IDPH was tasked to head up the Bioterrorism taskforce. Prior to the events of last fall over 1,000 physicians, nurses, EMTs, and public health workers were trained in bioterrorism preparedness and response. With funding from the Centers for Disease Control and Prevention (CDC) we also expanded our planning and enhanced our laboratory capacity. Funding directed by Governor George Ryan and with support from CDC a molecular biology laboratory was established in the IDPH labs in Chicago and Springfield. After the Anthrax attacks last fall on the East Coast of the United States, additional state funding was made available to facilitate the formation of a state pharmaceutical stockpile to assure that first responders will have immediate access to life saving antidotes and antibiotics while the National Pharmaceutical Stockpile was being mobilized. The state funding also allowed us to accelerate the adoption of PCR technology to test environmental samples for Anthrax in 2 hours as opposed to the 48 hours required before. IDPH welcomed the $1.1 Billion dollars that was appropriated by Congress for shoring up the public health infrastructure to assure that we as a nation are better prepared for another bioterrorism attack. Despite the short turn around time, we worked collaboratively with local health departments to craft an application and plan for enhancing the functioning of the public health system here in Illinois. Our bioterrorism activities build upon the strong foundation of preparedness disaster response that was already in place. IDPH has placed emphasis on public health system improvements that will be used every day. Already the enhancements in the IDPH laboratories are helping us better respond to the incursion of West Nile Virus into the state. Other enhancements will allow us to respond more quickly and better to outbreaks of other infectious agents. The attached document summarizes the activities that will complete as a result of our funding from US/DHHS. (Attachment 1) John R. Lumpkin, MD, MPH 7/2/02 Page 2 The following is a short list of some of the things that the grants will make possible: Establish core preparedness standards for the three-tiered facility classification system To demonstrate how crucial these grants are, I would like to take just a few moments to talk about the importance of just one public health system enhancement, the Illinois version of the National Electronic Disease Surveillance System (INEDSS). Despite the increasing sophistication of computer systems in hospitals and other clinical settings, the infectious disease reporting system is still based on 1920s communication technology. When a clinician identifies one of the 60 diseases that are required to be reporting in Illinois, a report is made to the local health department. This process is accomplished by filling out one of the paper morbidity cards and mailing them in. If the case is rare or otherwise significant, the clinician is expected to call the local health department. After investigation by local health department staff, written reports are then submitted to IDPH via US Postal Service mail. With the current funding all of that will change. The implementation of the INEDSS system will begin with the roll out of a module that will automate the transmission of infectious diseases notifications and investigations between local health departments and with IDPH. The enhancements in the Health Alert Network (HAN) assure that the infrastructure is in place for this electronic communication to occur. In addition this first phase allow the electronic reporting of cases by clinicians directly to the local health department and the state simultaneously. Other modules will be implemented over the few years. With these enhancements enabled by the bioterrorism funding we are improving the ability of local and state public health agencies to recognize and respond to outbreaks of disease of natural or criminal origin. Here in Illinois we are building upon a firm base of preparedness and response that has resulted from years of hard work. The new federal funding enables us to better meet our mission, to protect the people of Illinois from biological agents as part of a natural process or part of an act of terrorism. Once again, I thank you for the opportunity to testify and will be happy to answer any questions. Illinois Department of Public Health Executive Summary of CDC and HRSA Bioterrorism Grants John R. Lumpkin, M.D. Background: On January 31, 2003, Department of Health and Human Services (HHS) Secretary Tommy G. Thompson sent letters to governors detailing how much each state will receive of the $1.1 billion to help them strengthen their capacity to respond to bioterrorism and other public health emergencies resulting from terrorism. The money will allow states to begin planning and building the public health systems necessary to respond. The funds will be used to develop comprehensive bioterrorism preparedness plans, upgrade infectious disease surveillance and investigation, enhance the readiness of hospital systems to deal with large numbers of casualties, expand public health laboratory and communications capacities, and improve connectivity between hospitals, and city, local and state health departments to enhance disease reporting. The funds come from the $2.9 billion bioterrorism appropriations bill that President Bush signed into law January 10, 2002. The HHS funding is divided into three parts. Two of the parts will be directly granted to the Illinois Department of Public Health (IDPH). The first portion will be provided by the Centers for Disease Control and Prevention (CDC) and is targeted to supporting bioterrorism, infectious diseases, and public health emergency preparedness activities statewide. Each state's allocation will consist of a $5 million base award, supplemented by an additional amount based on its share of the total U.S. population. The Health Resources and Services Administration (HRSA) will provide the second portion of funding, which will be used by states to create regional hospital plans to respond in the event of a bioterrorism attack. Hospitals play a critical role in both identifying and responding to any potential bioterrorism attack or disease outbreak. These funds were allocated using a formula similar to that used by the CDC. CDC Bioterrorism Preparedness and Response Grant Overview: The purpose of the CDC cooperative agreement is to upgrade state and local public health jurisdictions preparedness for and response to bioterrorism, other outbreaks of infectious disease, and other public health threats and emergencies. Eligible recipients could request support for activities under all of the following Focus Areas. $ $ Preparedness Planning and Readiness Assessment. Establish strategic leadership, direction, assessment, and coordination of activities (including National Pharmaceutical Stockpile response) to ensure statewide readiness, interagency collaboration, local and regional preparedness (both intrastate and interstate) for bioterrorism, other outbreaks of infectious disease, and other public health threats and emergencies. Surveillance and Epidemiology Capacity. Enable state and local health departments to enhance, design, and/or develop systems for rapid detection of unusual outbreaks of illness that may be the result of bioterrorism, other outbreaks of infectious disease, and other public health threats and emergencies. Assist state and local health departments |