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Transcripts For CSPAN2 Key Capitol Hill Hearings 20150401

[laughter] >> thanks, i appreciate your comments. and i am intrigued by those that you wrapped up within the decision they can process for the preparedness and the allocation of resources and you find it completely ad hoc and disjointed and one response to that is democracy. it is a messy process with the location resources done by things allocated by criteria that might not always be rational. that is the reality of the democracy and the testing of the responsibility and the political executive branch. you mentioned in terms of how to fix it in rationalizing the democracy i think that we could agree you suggested this public health czar or official. any other specific ideas to lead from the federal level on how we can make that process a little bit more rational and going forward? >> well, i guess i would start at the top. i think the president staff and the cabinet have to come to some agreement about instructor for the decision-making that becomes increasingly more inclusive. and it gets down to the government and down to the real decision-making. now i know there are a there are a lot of meetings for example the deputy secretaries of the various issues have been happening at the white house. they go back to their agencies and, you know something happens or doesn't happen. but even in the attempts right now to bring people together tend to kind of dissipated rather rapidly. so i think that sustained leadership from the top is the key. secondly right now the reason i'm talking about this public health czar is there is no particular venue within the government as it is currently structured and there could be. it's not incompatible 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 don't think that it's the own human can to figure out how to reconcile the needs of our vibrant important industry with the public health needs of the country. we just need someone else to convene out and guide of that. but i mean, i know a lot of people in the industry because for a lot of various reasons and i don't think that anyone would refuse to participate in those discussions. we just need to have somebody leaving it where they come to the table knowing what they are saying and what they are concluding would have some impact and have some consequence as opposed to yet another meeting where you come in and talk and go back to business as usual. that is the cycle that has to be broken. and like i said i really wouldn't be so distressed if the decision was taken. you know, i am just using this as an example, it's more important for new york city's average in its schools for third graders reading at grade 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 rationale for leaving us to that conclusion. but you would know more than me about how to make kind of really operationalize this. >> if i could follow-up on the public health cannot get bunkers but if you could think about where they are structurally, that person would be. >> i think that person would have to report to the president. because blank in the white house. >> in the white house reporting to the present in some fashion or manner whether that works or not. it seems to be me the president whoever she or he may be we need to solve, it is in america's interest that we transcend the political differences and we figure out how to create a public health infrastructure that will help the whole country i don't know if anybody can say this with enough force or power in the united states. >> i think it is more complex than that. it would drive me crazy. another czar without any staff who has the president. so the problem here is you're talking about different decision-making structures for different incidences. in fact, the director commands the public health service in an emergency. the director takes over in an emergency. hhs relinquishes 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 and you are not required a different kind of decision-making structure, start by talking about the challenge of federalism to a assuming very assuming that we cannot get rid of the federalism the question is 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 if they go through the exercises? if you ask me what happens in my community for example i can answer almost all of your questions. i can answer them at the university of miami, with the county is going to do, but in general because of the someone like cragg, florida is organized for hurricanes but particularly for bioterrorism, but we are certainly well organized for hurricanes. we have seven days of them in all sorts of structures about 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. i can tell about the planes and bishops and we plan to a level of detail but bioterrorism and the kind of thing we are talking about requires to be a different structure because you have to have a public health infrastructure. but more than a public health infrastructure to the private sector has to be wielded together in the public sector. so, what we need to do this to think is to think about how you glue the system together and then i put it through a series of exercises so it works and everybody knows what they are doing. the fact is that nurses be heard to haven't heard the disaster plan is a disaster in itself. so it's figure out how to 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 of salt on buildings as affordable as they are. >> i don't think that reports to the president. i think it is just it requires more infrastructure than that in terms of who has the authority to make the decision. >> right now when you don't have a described -- >> it's really similar to express -- >> there is for emergency management at the hhs. >> my understanding is in 2012, new york city was flooded with people. the president said we will not have a repeat of katrina period we have every acid being organized not even in the office of emergency management. the mayor decided he's 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. whose operating it? doctors without borders. what are you doing here? while we were told to come here and help. [laughter] is my favorite place on earth but what the hell was this guy doing here with a table full of medicine and it was completely inappropriate and it was just kind of these random things. we had five mobile in the city and i was trying to figure out where should we put them and where do we go. where we went through just to sort this out and we never got a satisfactory answer we just had one in place. >> most of them tell people to stay out. >> the first rule is don't let a lot of people in. >> it's hard to stop. >> one of your colleagues testified earlier from chicago talked about coordinating activities as the local and state level and unfortunately i don't think that that is a model that has been used very effectively in 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 he will be in the same situation as you were in the earlier statement with good experience without lessons and lessons without application and in experiencing katrina there were blessings but most of them were not applied in sandy's so i guess even the rudimentary notion that after every disaster you get a debriefing of what has transpired. we are still not doing that in a very efficient way. so i think from all of the observations you made that's one of the most important. >> if i could clear up one thing, on your point about the decision-making process to be directed not so much at the way we operate and crisis left before the crisis, the government's ability to look ahead, prioritize one over another, one valuable for another value as you said education versus the preparing that was the failing that you were trying to address. >> they are coming up in the decision-making process that operates best in the crisis. am i wrong about that? >> we have problems in the decision-making process in the problems we download or planning on the local level. i go to a lot of planning meetings. the whole idea of having those people in the private sector that have so much to offer we need them badly. we will call to distribute the bottles of water that the whole process of deciding what to do and how to do it is not right from top to bottom but the last thing on the fundamental level we are not making those decisions into democracy is messy and i understand that. but we can't have poor disaster planning and horrible schools and broken infrastructure. something isn't good here because we have to figure out what we are going to -- we have plenty of money. we have to figure out what we are going to spend it on and do it effectively with smart people on both parties. >> jam, last question. you talked about the need for the military to be involved and you referenced going back to 1878 or something. the operation has taken a look at what the military role should be in these kind of disasters. have you actually thought through how the congress might rewrite the statute? and i would imagine the black helicopters would go crazy if congress started -- >> after hurricane andrew, the category five really devastated south florida. if you days later there were medical unit. colin powell was running the show. i may have slightly overstated that but for all intensive purposes, he was designated by the president to go down there and it was phenomenal it was a very different animal than what we saw in katrina or sandy. it is organized, effective it got done, people were served, it was a big mess, but it seemed to work. it was designed to keep the army from police officers in america. that is basically the essence. we cannot have the federal government becoming the local cops for state police or whatever. back fundamental principle is good. no one would disagree with that but it seems to have been extended to an arms length distancing of military and their assets and expertise when we really need them and by the way in addition to not having any private sector people we have nobody we don't even have the national guard represented. when nothing happens it's a little too late. we could keep you here but we have two more panels to do. >> thank you. [applause] >> panel three is now going to join us on the pharmaceutical responds. we have the ceo the president and ceo of the solutions, mr. mike managing director and the executive manager of the countermeasures distribution of the united states postal service. ladies and gentlemen, please come forward. it's been our ability to have the q-and-a i'm going to ask you to try to if you have written testimony to relate to the senate talking point so that we can review it as the most constructive engagement as the advisory panel has an opportunity to engage in the conversation. so i appreciate the participation. >> thank you very much. >> governor and members of the panel, at the last meeting, my friend -- >> is it not on? okay. sorry about that. governor and members of the panel after your last meeting my friend senator sheldon whitehouse spoke about regulatory systems in place to protect shareholders sorry stakeholders instead of encouraging innovative methods for solving existing and new threats that we face. i'm here to put a face on that issue as it applies to the vaccine development experiencing it firsthand. i know and i hope that you will know there are ways to respond to the biological threat than what we are doing today. i trust that by the end of my presentation you will know but also. i'm the infectious diseases expert and founder, ceo scientific officer. over the past 17 years my company has been engaged in designing vaccines that are more effective, safer, faster and cheaper to produce than those made with existing methodologies in the 1 cents, we are like many companies that have a solution potentially for dealing with threats that our company may be a little different from others. we've become successful by challenging the scientific status quo. it has been a struggle but i think that it is worth the effort and innovation can bring solutions to important problems. that's why i'm here to talk to you today. what is unique about the company is that we have special computer-driven tools for biological design. we also have the design concepts many of which have eventually percolated up to the level of the big firms to vaccines. when it comes to new ideas that need to be adopted in science but what i've learned and many of you know already over the years since 9/11 waiting for the ideas to percolate simply isn't going to solve the problems and these ideas may arrive too late before they make any impact. so what's the important idea we have a developed method for making more effective safer and potentially less costly vaccines on demand. the time to think about these is now. i realize many of these ideas may not sit well with incumbents in the vaccine industry including some of those that are present in the room but then again isn't always the way it is when the new ideas drive change? how do we do the vaccine on demand we use our knowledge of immunology scientific acumen and proprietary science computational tools to discover the components of the pathogens as well as those that enable pathogens to escape from the defense. as a result of the computational tools can allow us to design a vaccine almost immediately within 24 hours of having the sequence. we do it directly from the sequence of the pathogens is made available over the internet and not only can we it not only can we design them on the fly but we can also predict which vaccines will work and which will not. the approach is significant. a traditional vaccines are made using what i call the shake and bake method. take a virus or piece of bacteria growing up and inject it. that is a method that hasn't changed. the vaccines on demand over a potential and powerful solution to threats and the approach has broad implications for other vaccines in general but to implement these ideas the way we make vaccines the way they are designed developed, deployed and actually approved must change. that's the method and i'm here to tell you it is critical to change that in order to better address the threats we face today and to prepare those that we might encounter in the future. let me give two examples you are probably familiar with. one is the pandemic influenza one that emerged in mexico. it was shipped to the cdc and they checked it out and informed the scientific community. the bad news against the last season's influenza does not protect against the pandemic strain. we went further using our tools to determine that the same seasonal influenza have components that could be effective against the pandemic and that of the seasonal influenza could protect against the new pandemic. the cdc never looked at at that possibility even the possibility even though the literature was already replete with evidence. it could and would make a difference. we let our network know and we send e-mails around the world and reached out to the larger network so that the information could be taken into consideration when that response for the pandemic flu got underway. the message was hold your horses may be there are elements that could protect against the strain to reduce mortality and not filled to capacity as some were claiming. our findings told us that to make a new pandemic vaccine using existing methods would not even be produced in time and might be unnecessary. were we right? absolutely. do these ideas get traction? absolutely not. could we have dean as the panic of the studies had the funding than available for the innovative ideas? absolutely. but the bigger companies to go to group for the government were already in discussions about making a new vaccine using existing methods. nothing we said as loudly as we said it could interfere in the process since the connections were in place and the established approach was viewed as non- controversial. example number two. we put the same algorithms together on the new strain when it emerged in 2013. it is very worrisome and causes 40% mortality in people who are exposed and still cause great worry among the pandemic flu experts even yesterday there were two cases in china. so what did we find out about that? we found out within 24 hours of having access that the virus was lacking those triggers that would drive the response. it was a virus but again we sounded the alarm and predicted that of those in the government would make producing vaccines using the standard method would be poorly effective. were we right absolutely. did it make a difference? no. why should we care? to me it is a problem when the vaccine in our government is one of the police detective least effective that has ever been made. especially when the tools we have available to us now can ache a better vaccine and predict the outcome. so there is a better way. we produced a new vaccine that is only three differences from the original vaccine that was made. and we have shown that it's better. what is the chance of getting this to the clinic? i will let you know when i talk to my colleagues about whether they will fund a clinical trial. my message is that using innovative tools we can design and provide a recipe for the new vaccine within 24 hours of receiving the sequence of any threat and we can distribute that information electronically to the manufacturers anywhere in the world. my vision of the future is we can do that and distribute the vaccine and if regulations are updated, we would use the vaccine delivery vehicle and that could be produced and distributed to pharmacies or post offices wherever you might have in a few weeks of an outbreak. wouldn't it be great to have that in place. making vaccines on demand could save millions of lives and tens of billions of dollars. those dollars are being used now in step two created the vaccines being stockpiled in warehouses. after a few years it expires and new versions of the vaccines are put in place. stockpiling is a potentially an effective solution to creating a national bio defense system. if you think that making these vaccines in this way is science fiction, it's not. because we've done everything that i just described except package and distribute to the public. we made a vaccine for the fever and a live test funded and we are about to start a program for the q. fever that will be in the year's model. this is what the country needs today because no one knows what we are going to face when it comes to bio threats. the next threat could be a combination of two different agents combined with genes that give antibiotic resistance. what then is the only response that really makes sense. so the nature is that it disrupts the status quo. if we are so convinced why don't we move this forward? the barriers are so high that it's impossible for anyone other than the entrenched incumbents to participate and it would cost money for animal trials, the phase two tests, supporting documents. we no longer have the luxury of time when it comes to dealing with these threats. >> we don't have a luxury of time here as well. you've written some insightful statement and i would ask you to summarize so we can get to the other panelists. >> i want to thank you again for presenting these ideas to the panel and i do have several recommendations in my testimony. .. >> we also produce and deliver to the u.s. military a skin decontamination lotion for chemical threats and that is been provided to the us government as well as to friendly foreign military's across the globe. we were born into the bio defense space and we've grown up in that space so i appreciate the annals invitation to discuss our experience in the biodefense field and some of the excesses in some the challenges. we were organized in 1998 and really the focus was to acquire the product institute vaccine facility and our interest in the facility was that is where the vaccine for anthrax was being manufactured and he was being manufactured for the is department of defense. that time the u.s. department of defense was the principal government agency focus on bioterror both in terms of procurement and in terms of product development. of course all of that changed with the anthrax letter attacks in 2001. what we learned is bioterror is not a military issue only. it affects civilians and we also learned we were ill-prepared to address a large-scale bio terrorist attack on civilians in this country. so despite the significant event, what we saw was a fairly slow legislative response. it wasn't until 2004 we saw project bioshield, round. at the time it was a game changer. it was a significant piece of legislation that really changed the landscape for medical countermeasures addressing bio defense needs. there was $5.6 billion set aside over a ten-year period to support the procurement of medical countermeasures for bio defense uses. in addition, there was a longer-term plan that was being developed to address the bio defense programs going forward. at that time this is about 2004-2006, emergence having been in that space for quite a bit of time as a private company considered going public. what we found was there was tremendous skepticism in the public markets about the whole bio defense market in general. is a big growth market? is it a viable market quickly found skepticism and questions from investor bankers, and from institutional investors, from commercial banks anybody in the capital markets process had real questions about the viability for sustainability of this market place. it was brand-new. very few contracts had been issued to your questions about is the money real? can be accessed? how? who is going to get a? are these going to be profitable contracts? a whole host of questions and those questions created doubts for large pharma, and dissuade large pharma to really enter into this market in a significant way. for companies such as a merchant, the mid-cap and small-cap companies, capital markets were very good difficult but we wanted to access the capital markets to grow our business. with a new manufacturing facility that we wanted to build, to expand our production. we wanted to grow organically so the products we have in developed and wanted to grow through a mandate. capital markets is really the only way to go about doing that. we were successful by the way incomplete our public offering. other companies were not so successful and, therefore, remained undercapitalized. as a result of that being financially challenged even though they may have had contracts to produce or develop medical countermeasures with the u.s. government support they were challenging the milestones in some the goals and expectations that were set upon them, and those failures created further down in the general population in terms of the capital markets about the viability and sustainability of the field and general. so that was the picture pitch in 2006. over the last decade or so the u.s. government has really made significant strides in changing that paradigm. we have a much more robust and structured long-term plan and vision for the bio defense space looks like. and just think of some of these successes over the last 10 years or so. in addition to it with that pahpa come you're all familiar with that, and that established barda and barda has now set up on establishing a very robust and thoughtful mechanism for developing products to the point where they can be procured and used in a national stockpile to protect the nation. we also headed the office of the assistant secretary for preparedness and response, and that office has been designated as the leader in preventing preparing for, and respond to public health emergencies and disasters. following that we the establishment of fancy coordinating all the federal agencies who were instrumental in evaluating and assessing and responding to these public health threats. you have the fda cdc nih, barda, dod dhs and others. very critical because now have the coordinated approach. pahpa was just reauthorized, another two-point $8 billion set aside through 2018 and an additional $415 million is being set aside for advanced research and development. recently hhs just released the strategic and implementation plan which gives us real visibility as to their priorities operational and strategic and where their funding decisions might ago. or as an industry player i have a much better understanding of the infrastructure that is out there, the parser been set aside in some the budget allocations that the government is thinking about as they build this bio defense infrastructure. so that sort of on the policy side but i'd like to talk about some of the medical countermeasures that have actually been successful over the last 10 years. barda in partnership with several industry players now has achieved success to the point where we have 12 products any national stockpile to protect the nation against these bioterror threats. 10 of them are approved two of them are available under emergency use authorization. some have been tested reviewed and approved using which as you know the fda set that up as an alternative way to get these medical countermeasures approved where clinical trials are just not practical. they just cannot be done. they have also partnered, barter -- bart has partnered with industry to now established an enormous pipeline of medical countermeasures moving through the system, 160 medical countermeasures are in the queue. 12 are scheduled for either li the next two to three years. we have 12 approved or being procured from another 12 coming so we are at 24. this is a pretty phenomenal progress when you think about that timeline we're talking the. nine years, think about the funding that has been allocated, $5.6 billion. let me give you a comparison. one of the most established well-known and prominent biotech companies in the world if the u.s. government, publicly traded, household name, in the same period $33 billion spent on research and development compared to barda's i put six. 33 billion. the output, seventh approved products compared to barda's 12 or 10 if they are proved, and 12 more coming in the next two years. this is a phenomenal success story. it really is. it's an unheralded success story that we need to understand and appreciate. it's the paradigm that is working because it's not the government doing it by itself but it's doing in partnership with industry. now the problem as i see it is this paradigm has not entered all the questions that exist at the with respect to the viability and sustainability of the bio defense market and industry. so we are still not seeing a number of players, industry players, that we need in order to create the kind of countermeasures, the number of countermeasures that are required in order to address the whole portfolio of threats that have been identified. by way of example closer to home for us it's the only licensed vaccine for the provision of vaccine disease. since 2004 we been contracted to provide over 90 million doses to the u.s. government. in addition in partnership with a barda we have made tremendous strides in improving the product profile for the vaccine. for example, the route of administration is changed from subcutaneous to intramuscular. why is that important? as people get vaccinated the intramuscular route of administration much fewer side effects locally on the skin and subcutaneous. would also increase the shelf life for four years. why is that important? now you have a product that is being stockpiled twice the longevity than previously had. tremendous savings and benefits of u.s. government. we streamlined the immunization schedule. it used to be six doses with the boosters thereafter. now we are at three doses as a prime ministers with the boosters thereafter. very effective to the customer. we are in the process and expecting fda approval in august of a postexposure which is why the government is stockpiling in the first place but they can be used in combination with antibiotics, that's been tested, and deployed in a -- so after an anthrax attacks. so these are the kinds of improvements that are critically important and partners make the phone with her glass improvement, manufacturing skill. we are now in the final stages of moving our manufacturing from seven to 9 million doses of graham to 20 to 25 by doses a tripling of the production of the. why is that important? the government said its requirements 75 million doses into strategic national stockpile. current production levels will not get the. this will allow that to happen to want to talk about -- >> same time restraints on you too. sorry. >> that's fine but i want to point a couple of other infrastructure improvements that barda has. there's the center for innovation and advanced development and manufacturing moving across the country. would operate one in baltimore. report, flexible manufacturing and it allows for independent situation tens of means of doses, 50 to be exact and through such sites across the country to notion if we can protect the nation with flexible manufacturing sites. they have set up a network a network of clinical and nonclinical sites all with these work together to improve the infrastructure needed in order to address these vile terrorist threats. it's not just the product side and it's not just a policy side. they're looking at infrastructure that can protect the nation. so this is a real healthy maturation of the government thinking, but to be clear, we need incentives for industry to partner with the government. there needs the aggravation for industry to better understand how to plan for these kinds this kind of market the right that we don't have clear visibility on the size of the market the direction of the market, and what is the opportunity, what is the business opportunity for industry to partner with the government? that's in a way we need improvement. i do have recommendations on that but i'll be happy to share with you during the q&a. >> appreciate that very much. >> thank you for having me here today. i'm the management of consulting firm stokes athens. we are more of a general consulting firm, work across all industries, and in 2011-2012 we were brought in by the department of health homeland security to take a look at dispensing anticipation of medical countermeasures. looking at anthrax, several senators with the. what's different what we did is because we are supply chain experts, we can tend to look at the outcome and work backwards. with our enduring people. everybody had a lot of good solutions, but nobody was looking are we trying to win super bowl? what is a we're trying to do? one of the outcome measures that would most critical but we seldom overturned reduce the mortality, reduce morbidity. if you're starting with that as our outcome what is a we really need to get good at, what are the process measure along the way the really indicators of progress and which of these things have maybe become distractions where we hang a lot of weight on things that we can't really link through to the end result. so we focus on the processor today, we did quite a bit of work looking from a planning through detection and characterization through an initial distribution initial -- excuse me, dispensing and looking at ongoing dispensing treatment. we can talk mostly about the distribution of dispensing here today. so we talked to about 45 people, most of them are in this room today, and read over 200 papers and got educated. everyone was very, very cooperative, department of homeland security, state local. refund everyone in the committee was really willing to share their ideas, share their frustrations, share their input. so we were able to establish an end-to-end process model. being consultants, looking at all the different players, what their roles were what the potential breakdowns, identified about 120 gaps which stopped the system dead and its track. none of these were surprises to anybody, but nobody put it end to end before. when you look at into and it wasn't pretty and we said okay, we know that we can't change politics. we know we can't create a lot of money to grow a lot of resources. there's things that can be done. given resource constraints and given, of the 40 folks involved we can do better with what we do have. and so in doing that we really first looked at five real problems, and our sensitivity analysis exposed make sure all these effective people started complete, medical regimen is the most critical step in office change. so the biggest sensitivity is people either don't start their medication or the build completed their medication. that was the biggest single contributor to the other in the entire process. so there's a lot of pressure to get things out of quickly, get distribution, get apparatus moving. we found that not taking into account the behaviors of the people involved, the population and understanding their fear distrust, the inconvenience their ignorance, it may be of what was going on. we really had to take it into account. we found, without getting into specifics, the failure rate was about three to five times what most people estimate it would be in terms of recovery. while they would say we would have eight to 10% people getting sick we found using the numbers that were already published of different studies putting this together, we found over 10% of folks would never seek medication. of the folks at it only about half would take it based on different studies, and of those about a third or 40% would never complete the regiment. when you get that in place, especially anthrax, 60 day treatment regimen you probably want to try to either which is why vaccine and so many other tactics are important but also recognize that this is really a marketing issue and it's something that while it's very easy to allocate funds and resources to technology and technological issues that have the promise of having a big impact the softer issues of marketing and the population dynamics, also the fact that those are always changing any commercial company is cost of taking a look at the market place, understanding how the expectations of their customers are changing changing the channel, changing the mix of products to make sure that they can deliver what usually needed. do secretary shalala's focus on the, having dependence on distribution, dispensing mode particularly the point of dispensing pot model, limits options, existing infrastructure. why not build of relations that exist, on public trust that already exists and tried to offer alternative. single thread is a dangerous when facing an adversary. if we have one supply chain that has been tested single-user very easy to disrupt. one shooting at a pod now all pods are shut down. what do you do next? also reduce -- will amplify these issues. leveraging come existing internal become more critical in the future. hhs, all state and local folks we've heard from limited personnel, it's commendable but it's not sustainable. and also current plan does not address likely contingencies putting shelter in place options, multi-drug-resistant strains and as we heard about at risk populations with fully one-third of our population is under 15 or over 65. we have chronic conditions groups that we really don't have a good solution for that these ought to be address. that's great. no surprises there. that everybody has heard of these things before, but what we found and again we went and plague this back to folks in government and in industry and with all quite a few folks in industry in our discussion, make it clear our goal is to get pills and make sure and one continues taking their pills until completely been. if we better diagnostics or otherwise to determine it is safe, make sure we put that in place. it's to change attitudes. also something to that i think we been dancing around today talking about political decision-making from the top down i think is where we are but i'm in a genetic take a look as this is an architecture problem. we don't have a performance architecture. we don't have clear outcomes we can build towards. we don't know what game we are playing. comes back to the athletes, we don't know if i plague football or tennis. what are we trying to do that saves lives, and able recovery, and able in these areas enable us to get back to business as usual. then understand how the performance architecture is supported by processes supported by technology supported them by funding and resources. and also very important with shared services. things we don't have to re-create all of the gotcha but things that can be leveraged. we also said engaging public-private is critical. people are trusting of groups that they understand whether faith-based or community organization but how to leverage them, how do we create an easy on red. we heard from safeway and other companiescompanies that h1n1 response of the google buzz for them in california alone to respond to 141 different requests for information when they were helping to dispense it. such as in one state. they want to help. they just is really insurmountable. same thing in trying to move things across board would distribute things state by state because of how our policies and we will do it in many urban areas or in regional areas. we talk about events that may cross borders when people start to migrate after an event. how to make it easier? i won't -- we are using these treat their own communities preloaded with information. don't have to preloaded with countermeasures. so we can make better decisions. med kits other options again to preload some countermeasures to allow certain groups to be more effective in their jobs. we have to also get better at marketing, we talk to the behaviors and expectations so different groups understand there's different segments that are going to give not absolutely predictably but we can do much better job of anticipating where we have issues and really using the burden pashtun reducing the burden on our public health community to try to be all things are people a lesson focus where they are really the most effective and in looking at those folks on the fringes. and begin using existence challenge wherever possible. redundancy is going to probably create some inefficiencies but we have to look at that and say we have one unit for one your opinion. if we tried to be in that kind of situation, we are going to set ourselves up for failure especially when the consequence in public distribution, in complete dispensing is measured in sick and dying people. so i'm going to cut cut short the rest of this but it's kind of tight altogether you need to have somebody in charge of drive and architecture at the federal level that integrates all these great capabilities, that has a single set of measures that we can all try to wind do, people can make better decisions than with their own resources within their own scope of control but we can at least understand the impact of those and we can try to mitigate that or if necessary, try to impress upon those folks the consequences of those decisions. thank you. >> thank you. >> my name is jude plessas, i'm the acting director of continuity policy and planning in the office of the postmaster joe of the united states postal service. i would like to extend my thanks to the organizers of today's event and the chance to speak about the national postal model program. national postal or concept operations was created in response to initial request in december 2003 for an executive office of the president to the u.s. postal service. to consider the delivery of oral and abbas to residences enlargement of holding areas during catastrophic events. specifically the outer release of a biological agent such as -- the postmaster general after consultation made the decision this should be done voluntary by letter carriers. in february 2000 for the second health and human services, sector of the department homeland security and the postmaster general signed a memorandum of agreement to salvage policies and procedures for usps distribution overall antibiotics in response to an incident. later in 2000 for the cities readiness initiative a federal fund a program led by hhs launched an eight major cities and increasing their capacity to respond to large scale public health emergency. the primary objective was to divert especially but dispensing an abundance to the public within 48 hours of notification primarily through once a dispensing. in 2006 and 2007 drills were conducted in seattle philadelphia and boston. command control and communications were tested as well as engaging with law enforcement and schools and public information dissemination. in october 2008 u.s. food and drug administration approved a request an office of assistant secretary for preparedness and response at hhs for unique emergency use authorization. and a lot of postal participants receive small quantities of oral antibiotics for storage at their homes to be used by themselves and members of the household as directed by local and/or state public authorities. president obama issued an executive order on december 30, 2009 direct in establishment of a national u.s. postal service model for residential delivery of self administer countermeasures following and biotech. this executive order recognize the capacity of postal volunteers to deliver medical countermeasures quickly to every american household as unique national resource. in the postal service in conjunction with hhs teachers doj and dod, developed and submitted a model in response to the national security council staff approved that national postal model in 2010. hhs on postal service then formed a joint program in front door to the deployment of a national postal muddle through the establishment of venue specific postal plant. and 2011 hhs awarded grants to five cities to fund these initiatives. minneapolis and st. paul was established in 2010 louisville kentucky, established in 2012. san diego, california, operational capability established in 2012 as well. philadelphia pennsylvania, and boston, massachusetts, also in 2012. the objective of the national postal model to use personal equipment or facility quick strike capability to deliver oral antibiotics from the strategic national stockpile to residential addresses within a single day as part of local and state mass dispensing plenty of the model was designed to augment not replace the distribution oral antibiotics the of the aforementioned pot. formal activation at this federal level to the postmaster general based on the declaration of a public health emergency response to requests from the governor of the affected state. career letter carries management personal who have been solicited, trained and roster prevent as volunteers would be notified and activated. every delivery point received a uniform amount of material. into geographical areas receiving oral antibiotics all postal operations other than the delivery of the drugs was suspended at those residences would not receive mail that day normal postal operations would only resume winter to do so by local public health. operational capability in five cities established i think most of planning preparations were complete their volunteer outreach and recruitment, health safety support security participant training, and a conference of postal plan composed. identification solicitation of the posters to deliver management district, energy management team members and inspection service personnel whose done in each city. target number of volunteers was met and exceeded in all five. recommendations for all safety were based by regulation. osha compliant medical evaluation testing and training household and individual and about kids, prevent, mass provision to the participants themselves, prevent. to make it refreshes and collection from opt out and retirees. office provided carrier escort perimeter security as outlined in each city's strategic security plan to acknowledge again during tactical security planning was accomplished. security was the primary by local and state law enforcement in collaboration of the united states postal inspection service for postal trips to pick up and about its, drop them off at post offices, at the post offices themselves for perimeter security and escort to the carrier actually on the street making delivers the focus then was put in place. and comprehensive so plans were created for all five cities that include activision command-and-control, this tradition, deliver your and operations, delivery operation security and public information, demobilization and recovery steps. operational statistics from the program, for minneapolis-st. paul 205,000 residential addresses would've been served under the plan. 266 active postal participants were in play in that city. we need 172 security personnel in order to affect the nation. in louisville 244000 residential addresses would have been served, 291 active postal participants with 191 security escort requirements. >> all on a single day? >> on a single the. >> thank you. ask you to summarize. >> i'll skip over some of the operational statistics for the other cities and just say, for exercises, key element of the program was designed deployment of a series of exercises in each location your we held exercises a full-scale exercise in minneapolis-st. paul and functional exercise in all five cities. program expenditures were pretty slight. over the course of time postal service was allocated approximately $6 million, $10 million appropriation and there's actually still money in the budget. current status all five -- all med kits an open city were set to expire march 31 in 2014. a required replacement. at that time staff advise postal it would no longer fund and conduct health safety including the revision of med kits. instead hhs recommended that the usps work with partners to retain the resources it needed, for example, usps participants would receive date of event or about of antibiotics. this was not only contractor the original agreement but also supported by solid evidence. so usps deems the proposal unacceptable. all usps program participants have been placed in a suspension status the they are kept on the district participant roster in the hope of future revival. of the program is restarted current partisan will be contacted and is an active or suspicion to do to make it expiration, the post office plenty needs -- plays a suspension state as of october 2014. >> thank you. i know you had to abbreviate the last part, but you have a talk that fast in a long time. we very much appreciate the. it's a very important bill. i'm going to defer to my colleagues on the advisory board first. i'm sure you have some questions. dr. parker? >> thank you. excellent presentations. liturgical a couple of thoughts together here. first to borrow a phrase from dr. redlener. grande max prepared. what we are hearing here right now is we have the space of the need for innovation and the challenge status quo. we need the private sector involvement in this space in a big way, and we need to -- we need the proper incentives for the private sector to be involved in this space but we also need innovative ways to actually we make something to be able to get to the population quickly and in time. and even the postal system doesn't sound like innovation it is in this regard. we also have imposed on all of us in this whole system whether in the program in government or whether you're in the private sector trying to serve the public good in this space. you have federal acquisition regulations that inhibit private-sector collaboration and actually it becomes very risk averse to the business model of medical countermeasures development. and we need all this to be able we need innovation to drive change. we need that collaboration. do we need for any of the panel is, do we need a manhattan style project to really make us more effective, to drive, bring the innovation, bring better participation of private sector? and to bring to think about how to get out of a store they are needed? and also enable effective collaboration of the private sector as opposed to the competitive nature that the contracting process actually encourages which is kind of counter to what we need if we're really going to tackle this problem. so i would offer that to any of the panelists. >> who wants to start first? >> i think my colleague from emergent actually did a wonderful job of talking about the pluses in the program had been introduced over the years. there have been some really important advances. i still think that innovation in vaccines needs to take place. and that it will benefit a lot of people. and cancer vaccines we're looking at the immunotherapy is the use of technologies that i described. why aren't we making that available in the biodefense space as well as? >> i think and announced a project is not a bad idea at all. these are innovations that really are on the cutting edge i can build on an existing infrastructure of production that can be put to work to solve this problem. >> we talked last week. we do not want to throw the baby out with the bathwater. >> right. >> let's go down the line if you care to comment please. >> that was good to be my first, don't throw the baby out with the bathwater. because there have been successes and a tremendous progress has been made particularly i think is much, much better coordination between the civilian agencies and the department of defense, the resources across the government are really phenomenal in terms of the science that is being done, the development and the funding that might be available. where i see real deficiencies in giving industry more active is we need longer-term contracts. we need a much longer horizon in a way we think about setting up the special reserve fund. it was originally a 10 year fun as you might recall. the latest iteration it is down to five years to the return on that investment has been phenomenal both in terms of protecting the nation and setting up a dynamic where we have a growing now biodefense market. we need to keep that momentum going. i'm not against the manhattan project. i don't know what the end result is designed to achieve. so i think if we have a specific objective, maybe a manhattan style project is the way to get there. but i think we need to contend to build some on of the successes we've got. >> a couple things. i think jerry hit on it there's technical innovation and we've published research showing almost all value add in the last 20 years actually comes from the processor and getting that innovation into the hands of people to use it. so the first innovation is critical but it is expanding that so you get the most bang for your buck. so i think whether it's manhattan project or i think it's just how do you work and how to innovate around it, how do you introduce programs to expand the way barred operates operate to get more throughput but then also make certain it is getting yield, make sure you're getting the most leverage at every technical innovation and roll it out the also when we look at the trade space in medical countermeasures, you've got leadership issues, you've got technologies to include information technology, drugs, diagnostics, let just takes a people aspect, behavior. if we focus only the technology aspect with that understand how it gets through that, how it gives better tools to the leadership to make better decisions gives -- gives you better results for your population, we've got to look at all together. i think that sometimes we tend to look at the technology as being the only answer but we have to look across that entire trade space. >> i'm going to list you -- let you pass. director go ahead spent i have a question for the postal program and you had -- you're talking about the security concerns and the fact that the program is under suspension but when i was at hhs there was talk the postal union objected to the idea of the military's as distributors because of the concern -- mail carriers -- assigned each military which struck me as an unrealistic request given the times of national emergency. so how do you think the security concerns can be handled, if you think there's a practical way of going forward so this program can get out? >> we've been dealing with the security question from day one when this first came up. and the need for both health and safety support in terms of preevent make it provisioning and also the need for law enforcement on the street those were originally requirements. we went into each one of these five cities. in fact, as part of the grant process of cities had to come forward with the means to meet that security commitment. and they did so. that's how they ended up actually receiving those grants that were able to move forward in those five cities. it is a doable proposition. when you look at the number of law enforcement officers within a particular city and the number of carriers that we need on the street to affect delivery in the entirety of the city even talking in some of these in some of our cities that we went to, philadelphia, we covered the entire city. and we worked with them ahead of time to determine who can you put in place as far as security was concerned. so in order for us to have a plan in the first place, in order to say that we had operational capability in those cities we already had to have established that commitment with law enforcement. so that was met for those. we see the same thing going forward. if we were to reengage on this which on us it would take a certain amount of political push at this point. postal went into this because we were asked to come into it, provide this last mile service, which we do really mean for the entirety of the country, whether it be rural or urban. so we look at it as this is just a requirement that needs to be met in order for the safety and security of the people who are out on the street. we also think it's just a good idea. if you're going to have come its but have a team concept, someone who is out there who is paying attention to conditions on the ground someone else was being attention in terms of the delivery function so. where am i going, we went to go next? >> went with his political push to reengage have to come from and how heavy of a push would have to be? >> at this point in time i wouldn't want to put words in their mouth. >> one of the things we refer to come it's one thing to distribute in times of calm in normal times, but it is a crisis in a community, you could use most law enforcement for more traditional responsibilities. so with one thing in -- again fairly certain you would be comfortable delivering, if there was no problem but if in the know of the crisis, an usher going to be able to get a law enforcement personnel to provide the security. i think that's what you were alluding to at that moment. something had to address because there is no good answer. the bottom line is at a time of christ to the traditional responsibilities for law enforcement in helping to deliver a much-needed therapeutic vaccine to the population may not be their highest priority. >> can i follow up on that? >> please. >> you mentioned a decision was made that it would only be a voluntary assignment of the postal carriers could opt out of it seems like one of most ap aspects of this idea is that you already have for every house and every company in the country a human being assigned to go deliver there. ideally okay, that person will be going there, that person can then take the countermeasures to that house or to the company in a time of need. if people can out out then that seems like it defeats part of the purpose. my question to you is why was it made voluntary ?-que?-que x was a security concern? >> we operate in a unionized environment, and so it's not part of a collective bargaining agreement to a carrier on the street in that kind of situation we've got a public of emergency declared, people are being asked to shoulder in place or being asked to shoulder with her particular amount of time and then go to a local point of dispensing. being outside of those collective bargaining agreements, the decision was made to we approach the union speak with them, talk to them about recruiting individuals to join the program. and becoming participants within the program. >> in those cities where you actually tried to roll it out how complicated has been the people have been able to opt out? >> we went in. we were recruited. we always recruit to whatever we could, whatever the maximum. we were shooting for particular target in terms of x number of postal routes we need to me. we're taking on all participants in that regard. we were able through the recruitment process pull in enough people to be able to provide for coverage based on the coverage area which the local public health or state public health in the case of minneapolis-st. paul had decided upon. >> so the post person go to the door or just put it in the mailbox? >> they would be going to mail receptacles because that's the way that our routing is based. >> right. i think what this tells us as part of an overall strategy, i personally prefer the drug distribution center in the midst is because i think it is secure and it has an i.t. system that a company that can actually track it better. but as part of an overall strategy i think you use everything you can to you use the sources for the offices for heaven sake. they probably have more people who show up there. [laughter] >> question for dr. degroot. you are highly educated, deeply experienced, award-winning physician and scientific you proposed repeatedly a paradigm shift in the way we develop vaccines come and get you said you have gotten no traction. no one is responding to you positively. some time to understand why that is because it seems like it's a fairly straightforward scientific question. >> she wants to do without going through the long fta process of the. she wants the fda process, we've got to talk about safety. you want the fda process that? >> i think the fda process can be revised. >> it has been revised. you can do it fast track -- >> even for -- that's a great example. so there are ways to look into the way it is being done now. can we identify delivery vehicles that can be approved? similar to influenza vaccines for today. we use the same kind of trojan horse influence of iris and just slot in a new gene for the particular virus that is the flavor of the moment. weekend certainty that for bioterror. i think we are not we are one of many companies proposing that the we got to rethink the way that we approve these vaccines. with all due respect to the animal rule, in many instances of the vaccines that we are producing cannot be tested in animals because human responses are different. there are new models available that should be evaluated as means of testing vaccines before moving them into -- >> is the fda process the only path to your proposal? >> i could have a significant impediment is the way that this kind of work is funded. so, for example we work through the sbi system which has been cut dramatically in the last few years for many reasons as people are well aware of. and we had grants that had extremely good scores that were not funded even though we full pathogens that are considered bioterror threats. those we could not get funded because of those situations in place but that should be a priority. barda, which does a great job, cannot reach across the invisible line that separates it from the nih to grasp the most interesting projects that should be developed further because they are considered r&d. may be where we should set a cutoff for barda is proof of principle in animal models. not a stage when the trial. so reset the tactical level of readiness so that we can actually reach into an h. and pulled out projects that are actually innovative but not yet ready for the clinical trial. because the companies like mine don't have the funding to get into the clinical trial. >> thank you. >> anything? >> that's a relatively easy thing to do but it featured than it should be, or sounds, but that's something that can be part of a recommendation. >> we've heard that many many times. i want to ask a question about this whole flexible manufacturing. i think about your testament about vaccine on demand and then you've got to do some clinical trial. you to have the manufacturing capability. if you can expedite the clinical trials, is it conceivable that is a place or a venue or two that government should primarily fund? to build a venue that a small compass could use, but the large ones can use in the event you need massive production in response to a crisis? it's interesting, the whole concept of flexible manufacturing. not only visible to the individual company but the broader community. let's face it most of the innovation comes from small companies, not the large ones. that's the way it works. you are not going to manufacturers with got to move along quickly. do we need flexible manufacturing facilities? >> it's a great point, and that is the concept and it's not funded solely by the government. this is a partnership where the private industry is funding a part of it and government is funding a part of it and it is designed specifically as you state, search capacity, all for advanced development of products that are in the clinic so they can scale them up and make the more readily a table. so that's the paradigm. you described beautifully. there are three that exist today. could it be expanded to others? sure. part of the problem that my colleague is expensive is that capital formation problem. she doesn't have the money and investors are looking at the think it's too high a risk. how do we know the government is ever going to get by that? part of the paradigm we didn't think about is how do we enable companies like hers to get funded early on with exciting innovative technologies, maybe within h., is there a way we can take about that kind of funding the fables of these kinds of technologies can have a more appropriate fair hearing? those are the types of things i would submit should be priorities for the panel because if you want industry involvement, and i agree to point about innovation being an industry, we did it ways for this market to grow to be sustained and to be viewed across large and small companies as a very attractive opportunity for business growth. >> one of of the fundamental questions of what should government be doing and when does it profit share. we're talking about vaccines to which the margins are smaller than other kinds of drugs. it's a complicated question. >> will this apply broadly beyond the fence. i would just add to the wonderful comments from my colleagues that what we also need is innovative steps. so that's what we really been having trouble getting r&d before. we also have been able to look at existing vaccines and say wait a minute and we don't think this is a good idea. there should be a place for us to say that where it's going to be heard. really, there's no one i can talk to my experience during h1n1 and 87 and nine is that the cdc doesn't want to do. people do not want to hear that the vaccines they're going to make, the vaccine we have currently today is the least effective vaccine that's ever been made. we told you that in 2013 when the virus was published. >> when the virus was what? >> when the sequence was published. we published a paper saying the vaccine was a stealth virus. new vaccines would be ineffective. less than two months later we were proven right. >> any further questions asked what i think you talked about and inertia encoded the we've been doing the same things the same with a long line team -- time. what's the quickest way to design the components test equipment and get it out. three to five your process is not going to work. personally i think the panel would be interested if you have specific recommendations with regards to companies with yours we would like to see them. and the government generally. i think your companies come your type of companies was the epicenter of innovation in the space, great pharma companies they do things your ways. a different approach i think this panel is consider both. >> i want you to address the safety issues because the public will not tolerate, particularly widespread vaccine something that hasn't been properly tested. >> i think that's going to be addressed. >> i just want to make sure the secretary, i'm not looking to shortcut safety measures i think the whole process can be truncated. it is still too long. spent i think that actually were doing this kind of work with this competition tools that were actually addressing safety and there are things that we're learning about vaccines with these innovative tools that can improve the safety of existing vaccine. i think we need to hold the doors open to innovation while as i agree with the secretary of state will remain a very important issue. >> it's still the number one priority. >> yes absolutely. >> we thank you very much. folks come with going to take a five minute break not a 10 minute break. we will have the fourth panel of pure by 3:00. [inaudible conversations] [inaudible conversations] [inaudible conversations] [inaudible conversations] >> we will continue with live coverage of this biodefense conference hosted by the hudson institute shortly. as you are this is a five minute break but when they reconvene to discuss will turn to some the challengechallenge s posed in the cleanup of bio and chemical its post and affected as. including a look at cutting edge technology, lack of agreement regarding agency responsibilities and implications for future preparedness. that is expected to start just after 3 p.m. while the spray continues and gets and what congress continues their two-week holiday break which began last friday. many members are taking time to travel abroad during the break. speaker john been is with a bipartisan delegation in the middle east and today he was in israel to meet with israeli premise or benjamin netanyahu. after that meeting they made remarks to reporters for just under five minutes. >> mr. speaker, john, it's great to see you again. your visit is an opportunity for me to thank you and your colleagues for both houses of congress and for both sides of the aisle, for the warm welcome you gave me in the u.s. capital. and today it's my great pleasure to welcome you and your delegation to jerusalem the capital of the state of israel, the capital of the jewish people for 3000 years. john, your visit here is testament to the historic and enduring bond that unites our two nations our to democracy. this is a bond that is founded on our common values, our shared commitment to liberty, and equal rights for all. and his allies the value, they cemented by our common interest. i believe it's plain to see that those common values and interests are clear than ever. the middle east is plagued by anti-western anti-democratic and anti-american extremism. terrorist brutally behead their shackled captives before video cameras. desperate lead their people and chance of death to america while building intercontinental ballistic missiles to reach america. in this violent and unstable region where states are imploding fanaticism is exploding, one thing remains rocksolid -- our friendship, our allies our partnership. it makes both our country stronger, it makes both our countries safer. it is the anchor our shared hopes, for peace and stability in this region. so let me use this opportunity of your visit to reiterate something that i've said before but needs to be said again and again. the people of israel now that we have no better friend in the world than the united states of america. at the american people should know that they have no better friend in the world than the state of israel. john, you are one of 12 children. well, you came to the right place. .. is bad as you start with an opportunity to up an opportunity to be here and it is real at this time. let me take a moment to say congratulations on every election. the hard part begins now. we are happy to be here. thank you. it is a pleasure to see each and every one of you and i would like to offer you some lunch. >> speaker john boehner is in israel as they continue negotiations on the agreement on the develop of the newsletter technology the talks have moved past the deadline last night and appears to have backed away from some of the key elements of the deal. before the next panel begins in a few moments remarks from former congressman mike rogers as it got underway this morning. >> [inaudible] [laughter] >> i just covered that as secretary. thank you very much. >> exactly. but i do appreciate the opportunity and the work of the panel. i've been out for a couple of months and the intellectual firepower is both inspiring, and i've learned a tremendous amount. you think you come in fairly well schooled and realize you have a long way to go when you head out with fellow colleagues at the institute during powerful work. i thought i would tell you our journey on doing a bipartisan way the bill and the pop-up bill on the issues that we didn't believe are going to be addressed because it just is hard to get peoples attention about people's attention about something you can't see or touch necessarily but you know the devastating consequences and there are many nights as the chairman of the house intelligence committee you don't sleep for things that you know. often, there is the threat matrix of the attacks in our ability to respond in a way that would be completely inappropriate. so, we started in 2006 after a series of inquiries into the status of the terrorists attempting in their interest in obtaining weapons and we found a high degree of interest obtaining weapons that we are but we are in the middle of a conflict and iraq and the middle of a conflict in afghanistan at that point and the focus wasn't just necessarily where it needed to be. looking back with the white house at the time the administration collectively working with the white house we agreed we needed to have a special fund or effort to promote his countermeasures and that is the biggest problem. i don't understand if it is radiological exposure, i don't care if it's smallpox on a large scale or the plague which we have seen strong interest trying to weaponize and try to find delivery systems for them. we realized that we needed to have something on a larger magnitude to have both stockpiles of this and try to push it out to the first responders in the communities where they could gain access. that's how this started. you could imagine it was hard to get people's attention and so i credit the white house for saying this is something we have to deal with given the levels of trust. they were trying to get .-full-stop things we got the authorization money set aside for the countermeasures. >> scientists that i pronounced it correctly, while i'm learning doctor ken stanley consultants mckinsey & co. in the proliferation in the bio defense policy and homeland security council and welcome. >> can you define counter proliferation for me? spinnaker that would be the way that we prevent >> of the easiest thing to say is to prevent the transit of illicit materials from one actor to another. thanks for the opportunity to present. that's framing remarks on the context and how the response and recovery are interrelated in the event. the outbreaks when they occur. even when the loss of life is limited they could affect a relatively small number of people that cause significant economic loss. at either side of the globe can impact and i would be speaking about the recovery particularly in the context today what we've seen in the recent events. but it also emphasizes when thinking about response and recovery the evidence that we've witnessed to date do not represent what the worst-case books like so if some of these pathogens have been more easily transmissible were more pathogenic are in response to the recovery to the much more complex and substantial. now a quick few words about the connection in my mind about the response during the event and recovery during the bio event. in the context of the infectious disease where the illness may spread from. it would be helpful to think about the response and recovery of the same breath. i think about four particular areas of marie building the capacity of the system, second, establishing adaptive behaviors for the new normal, third restoring public confidence and forth, reviewing and updating the response, plans and activities that you've put in place. is that by it, by saying all of that i think recovery in many ways is dependent on the response that is undertaken. and the intensity of the rebuilding efforts to restore public confidence in many ways depend on the success of your initial response. to highlight what i've seen in terms of best practices in three areas, first effective decision-making and accountability, second, capabilities required during the response and recovery and then third, activities during the recovery. so first, when thinking about the decision-making during the response and recovery, to best practices that i would like to highlight for you are the articulation of accountabilities in the responsibilities during the response and recovery phase and second, exercises to practice and refine the decision-making procedures and executions. so when we think about accountability i think we've made great strides in the past year's independent mac in the preparedness act into reauthorization in 2013 provided us with enhanced structures to the decision-making response. but from where i've seen in the government service, best practices would indicate the agencies for help response during both domestic and international health crises. when we think about things on the international stage we think that the specific responsibilities and the spirit of the hhs and when we think about the domestic responsibilities they would play a much larger role. there's an opportunity to improve the process during these events. so, i think that the decision-making process and timing during an event is different than business as usual. so, often than business as usual times they look for an answer that give you more information over time to come to a better outcome eventually. there is an opportunity based on the best practice to conduct additional drills and preparedness activities particularly in the leadership that would be involved in early decisions for both response and recovery in order to refine the ability to make the decisions. because this from a sort of organic perspective decision made him like this doesn't come naturally to most institutions. more powerfully we can respond and recover for that. >> the second thing i want to talk about is the capability to mount an effective response and recovery. so, there are two emerging best practices to highlight. first before playing capability to respond to and recover from these events and a second, but strengthening of the reserve capacities and response recovery. so i think about three primary objectives to provide appropriate treatment from those suffering disease while minimizing the impact on the system overall. second year investigating using the epidemiological techniques to characterize the event. we have difficulty deploying human resources to the field quickly. many of you are aware in the recent perspective piece during the response particularly with our ability to recruit and deploy the human resources to the field. with a great deal of care i think they are overwhelmed in some of our most recent crises. for the knowledge that you need and the type of expertise that you need with the scale of response. they have a need for the types of capabilities where we have a response like this. we have recent examples that we've built with both domestically and internationally and we should keep in mind that what we may face in the future could be much more severe and therefore much more complex. the fourth observation i would make is that there's actually been an increase in the number of responses over time. i will go back to the two best practices. we would consider additional full-time capabilities to be on-call for response during a medical event and that would include people like planners communications experts and additional medical responders. i think we've also made great strides in creating reserve capabilities. we could when thinking about a best practice further strengthened the reserve medical capabilities. seeking out on-call responders who can be trained on an interim basis is in-line with those necessary in line with those necessary for the evidence that we would anticipate and you are compensated in a way that makes the service possible on very short notice for some extended period of time. if a third area is most explicitly recovery so as i mentioned at the top it has multiple components. >> i'm going to ask you to wrap up. >> you've got it. one of the recovery capabilities is reviewing the plans and activities. so i will confine my suggestion here to considering the recovery in the context of preplanning. so come at the acute stage of any crisis you have an opportunity to actually take the concrete steps to actually increase your level of preparedness. and i would highlight that you can focus on planning, training and then exercising in a much more concrete way at the conclusion of some of these events. i know that our time is short so thank you for the time. >> any final conclusions in the area? a couple principles you care to share with us a-qwex >> i will leave it there. >> thank you for inviting me to speak. i am going to focus on some remarks on the science technology advances that can and hands threat awareness in the biological events because both are central to mitigation and recovery and the key aspect of both is that advanced planning to minimize potential vulnerabilities in the detection response recovery pathway and maximize the availability and accessibility of the response resources such as medical measures and detection technologies is extremely important. as part of my remarks i will highlight some of the vulnerabilities but i want to have you think more about the whole system from prevention to response and recovery. just a way of background for the past five or six years i've been working closely with the fbi special agent you had as a panelist last time and most recently we produced a product on the transnational security implication and that open-ended and the door to the capabilities from the reliance very heavily on the digital technologies and how about no night creates some risk but how to present the risk. in addition to that some of the work that i've done in the middle east has been on the risk mitigation and so it's from that perspective today. in the countermeasure enterprise the presidential directives and public health, the select agent and regulations and now you've got efforts going on for the bio risk management which is laboratory safety and security in the united states and abroad and at the agenda was launched last year which builds on the 2005 international health regulations and the u.s. government policy on the bio surveillance. this is the system working on the prevention and response. and new advances to both detect the biological incidences, mitigate risk before they transfer and respond to incidents through the variety of different means. it these technologies offer significant capabilities on whether the threat is an actor who's expressed interest in carrying out a terrorist act. whether they are using biological agents or the threat of an outbreak or a release of a harmful pathogen. and they also provide insight into the detection and/or characterization of the infectious disease threat that would initiate response activities as well as developing medical countermeasures in the decontamination strategies to the facilitated response recovery. it's a big data analytics. it's described in the integration and an analysis of data generated from a number of distinct sources and from more than one data set. it has a high degree of uncertainty. the data can be deposited into the databases such as personal genome databases are included into the database such as internet search terms into purchasing preferences. it can be born digital such as the social media comment or the data from observation to information such as the data literature. it can be analyzed using a number of different technologies all of which the government and others are investing in. they are natural language processing recognition machine learning, social media analysis and mathematical statistical analysis. two examples from its played a role already in the prevention and detection of the biological threat. so one example is the global tourism database that uses media and social media analyst is to provide a picture of which actors pose a threat and which individuals and groups have expressed interest in using biological agents as the means to cause harm. officials can be better equipped to determine whether certain nonstate actors are acquiring the materials needed to develop or carry out an attack with biological agent were strategies that undermines the likelihood an attack will be successful. another example integrates data from human and animals in the surveillance systems, news outlets, clinical databases detect catastrophic outbreaks and in addition to locate and index and outbreak which is important when trying to rejected a defense in these warnings help officials, who shows. co. officials can control the current opry can to prevent further infection or disruption. this is that the only program. there are several different networks that try to build up some of the large data sets. examples include the global outbreak resource center which is all part of who google trends and models of infectious disease studies which is something they support. all of this is just a prediction of an outbreak is catching on and i saw a paper that said china has described the benefits of using data analytics for their natural disease capacity so this isn't just a u.s. or who thing. another example of this is that in 2013, the cbc launched a protected the influenza challenge which was designed to encourage innovation and influence of modeling prediction and they used the 2013-14 flu season. so where can these technologies and to the capability to detect a threat or a hand up to the ultimate gate to the krispy -- mitigate. we find the broad acting countermeasures determining whether the function of biological components can be determined through the sequence analysis, you vow you ate a potential damage of the biological incident identifying possible discrepancies and confidence building measures predicting malicious behavior in the broad set of information or evaluate the lessons learned from the man-made events. it's very vulnerable to the exploitation. over the last decade or so it is no surprise to anyone that computer systems and databases have become prime targets for hacking by amateurs and nonstate actors and that u.s. is concerned about protecting the critical infrastructure through the cyber attack. because of the privacy of the hacking of the health healthcare networks being able to provide people and i just wanted to point out that in the last six to nine months. the health information has occurred in 2014 and the hospital community health system in 2015 earlier this year and done, which you are all familiar with the 79 million records were released around the same time they were also hacked and that was 11 million records but what was different about this is that included medical records. several technologies exist to prevent from gaining access to the computer system yet non- state actors and the states are still conducting cyber attacks to disrupt computer systems, steal information and despite. as you all know last year, the president's council of advisors for science and technology issued recommendations on the technology needs to reduce vulnerabilities and enhance privacy. and of course we have had for years huge investment in workforce prevention capabilities in response, yet the u.s. is not well structured to address the cyber facts on the sectors where the insult is in the cyber realm and the output is in the release of biological agents from the laboratory is the way of infectious diseases detection or theft of proprietary information about the countermeasures in which the u.s. is investing. >> your full testimony will be part of the record if you have some conclusions and give us a chance to get back to the q-and-a. >> i won't going to the three d. printing but i do want to sort of talk about the cloud-based sharing. in the 2011 we were able to identify a 2011 outbreak that occurred in germany and france as one that was natural and not man-made just within 12 hours by the sequences being posted on the cloud and scientists being able to ballads that in the sequence and do some analyst is. it's through the cloud sharing and the analytics that we've are able to do that so these are capabilities that we do with a vulnerability and the conclusion i would leave you with is that we need to think more strategically about the cross domain direct and threats and multidisciplinary threat and capabilities that they offer and that we are not really fed up to be able to look at the risk and benefit and compare the risk and benefit of something that does not involve the 15 pathogens in experiments. hispanic can we follow up on the response that's an interesting focal point. thank you for the opportunity to address the panel today i will limit my remarks. >> we are intrigued with the unconventional concepts with recovery mitigation so we are all ears. >> i will do my best to keep you entertained. [laughter] the constant refrain through the bio defense if you will are the requirements resources training skills capabilities needed to respond perfectly justifiable and reasonable i think that we missed the key question in this which is more importantly what is the best that we can do with what we already have almost without exception any advance to require the funding that is needed to prepare whether it is in the response dedication. however almost equally without exception. we fail to read due to commit the requirements. in the plans but prepare for how to optimize in the use for the resources and capabilities that we actually do have that tends to lack the preparedness and the entire spectrum of early response to an incident. for example very few people are aware that the realm of the pharmaceuticals and medicines those are almost identical to those used for human beings. in many cases they are actually manufactured in the same plans where the drugs are manufactured for human beings. the primary difference being simply that they are packaged differently. that's. that's the dosage i would use for a five or 10-pound cat cat or ten or 600-pound goal is different and i would use for the human being but the drugs are the same. i have never seen a plan that actually looks at reaching out to leverage the pharmaceutical supplies for the agricultural arena to be able to make of the agency for the shortcomings we would have been a human event. while i do not advocate replacing the list of requirements that we need frankly that provides money and resources, jobs and other things we need to also added to these questions how to optimize the use of the resources that we have given we have nothing more what is the best we can do. the second issue is there tends to be a focus on the

Transcripts For CSPAN3 Politics Public Policy Today 20150406

>> i'm the acting director of policy and planning. national concept operations was created in initial request in december 2003 from the executive of office of the president to u.s. postal service to deliver oral antibiotics during large catastrophic events, especially the outdoor release of a biological agent. the postmaster general made the decision this could be done voluntarily. if health, safety and security were provided. in february of 2004 the secretary of health and human services secretary of the department department of homeland security antiagreement to establish policies for oral antibiotics. later in 2004, the city's initiative federally funded program led by hhs to launch in u.s. cities to respond to a large scale health emergency. the primary objectives are to avert mass casualties and dispensing antibiotics within 48 hours of -- the postal concept because an -- offering an additional method of drug distribution to the general population. commands were tested as well as as -- in october 2008, the u.s. food and drug administration approved a request for a unique emergency use authorization. it allowed postal participants to receive small quantities of oral antibiotics at their homes to be used by themselves and members of their households as directed by health authority in the case of a postal plan and for find lg amendments in 2009 and 2011. president obama issued an order in 2009 measures falling in bio tech. this recognized the capacity of volunteers to deliver to every american household as a unique national resource. developed and submitted a model in response to the national security counsel staff who approved that national postal model in 2010. the postal service informed a joint enterprise through the establishment specific postal plans. in 2011 they orred granted to five cities to fund these initiatives. minneapolis st. paul capabilities were established in 2010. louisville, kentucky established in 2012. philadelphia, pennsylvania and boston massachusetts also in 2012. the objective of the national postal model personnel equipment, facilities to provide quick strike capable thety to deliver oral antibiotics from the strategic national stockpile to residential addresses within a single day as part of local and state mass dispensing plans. the model was designed to augment augment, not displace. formal activation at the federal level to postmaster general based on the declaration of a public health emergency response to request from the government of the affected state. career letter carriers would be activated. antibiotics at in a local, state authority would be delivered to all residents in a set area. in the area other than delivery of the drug to be suspended. those would not receive mail that day. normal postal operations would not resume to do so by local public health. operational capability in five cities were complete. volunteer outreach and recruitment, health, safety support, security, training and a copy of the postal plan. a pool of carriers, delivery, management, district and emergency management team members and inspection personnel was done in each city. the number of volunteers was met and exceeded. recommendations for health safety were developed based on osha regulations. the process included screening. conditioning of individual antibiotic kits mass provision to the participants themselves. that gives -- in the entire region. commitment officers provide carrier escort and perimeter security as outlined in each city's plan. and acknowledged again during tactile planning. security was done primarily to local and state law enforcement. for postal trips to pick up antibiotics, at post offices themselves for perimeter security and experts for the carrier ons the streets making deliveries. focused training is put in play to specific day of responsibility and comprehensive postal plans were created for all five cities that included activation command and control, distribution, delivery operations, security public information, demobilization and recovery steps. for minneapolis st. paul 25,000 residential addresses would have been served under the plan. 266 were in play in that city. we need 172 security personnel in order to affect the mission n. louisville, 244,000 residential addresses would have been served. 291 active postal participants with 191 is security escort requirements there. >> all in a single day? >> all in a single day. >> thank you. ask you to summarize. >> i'll skip over the some of the operational statistics for the other cities and just say for exercises, key element with the program with design and development in a series of exercises in each location, tips on exercises, a full scale exercise in st. paul and functional exercises in all five cities. program expenditures were pretty slight. over the course of time, postal service was allocated approximately $6 million. $10 million appropriation and trs still money in the budget. current status. all five all med kits in all five cities were set to expire march 31st in 2015. they require replacement. at that time leadership advise is no longer funded including the provision of med kits. instead, they recommended that the usps work with local partners. for example usp participants receive event provisioning on oral antibiotics. now, this was not only contrary to the original agreement, but solid evidence of efficacy, so they deemed it unacceptable. all usps program participants have been placed in a suspension status. they are kept op the roster in hopes of future program revival. if the program is restarted lack of funds to maintain operation were explained to each of the five cities placed in a suspension state. >> thank you. appreciate it. i know you had to abbreviate. you haven't talked that fast in a long time. it's a very important panel. just going to defer my colleagues first. i'm sure you have questions. dr. parker. >> thank you. excellent presentations and let me try to pull a couple of thoughts together here. first, tomorrow, dr. redletter at our lunch talk, random act of preparedness. what we're hearing here right now is we have the space of the need for innovation. and the challenge status quo. we need the private sector involvement in this space in a big way. and we need to proper incentives for the private sector to be involved in this space. we also need innovative ways to actually, if we make something, to be able to get it to the population quickly and in time. and even though the postal system doesn't sound like innovation, it is in this regard. we have imposed on us and this system, whether you're in the program and government or whether you're in the private sector trying to serve the public good in this space -- it becomes very risk averse to the business model of medical countermeasures developing and we need all this to be able to, we need innovation to drive change. we need that collaboration. do we need for any of the panelists, a manhattan style type project to really make us more effective? to drive in, bring the innovation, bring better participation of prift private sector and to bring new thinking about how to get countermeasures to where they're needed and also enable effective collaboration of the private sector as opposed to the competitive nash that the process actually encourages, which is kind of counter to what we need if we're going to tackle this program. >> who wants to start responding? who wants to start first? >> you know, i think my colleague from emerging did a wonderful job of talking about the pluses in the program that has been introduced over the years. there have been some really important advances. i still think that innovation in vaccines need to take place and it will benefit a lot of people and cancer rack seens, we're looking at therapies that use the technologies we described. why aren't we making that available in the bio space as well. i think a manhattan style project is not in place. these are innovations on the cutting edge that can build on an existing infrastructure of production that can be put to work to solve this problem. sxwl and we talked last week, we don't wabt to throw the baby out with the bath water. >> go down the line if you care to comment. >> that was going to be my first comment. don't throw the baby out with the bath water because there have been so many successes and i think tremendous progress has been made, particularly in defense and i think there's much, much better coordination between the civilian agencyies and department of defense. the resources across the government are really phenomenal in terms of the science that's being done, the development and funding that might be available. i see real deficiencyies in getting industry more active is we need longer term contracts, we need a much longer horizon in the way in which we think about setting up the special reserve fund. it was originally a ten-year fund as you might recall. the latest is down to five years. the return on that investment has been phenomenal. both in terms of protecting the nation and setting up a dynamic where we have a growing now bio defense market. we need to keep that momentum going. i'm not against the manhattan project. i don't know what the end result is designed to achieve. i think if we have a specific objective, maybe a manhattan style project is the way to get there, but i think we need to continue to build on some of the successes we have. >> their second motivation is probably some research showing almost all value added in the last 20 years actually come frs the process around getting the innovation into the hands of people that use it. first innovation is critical. expanding that so that you get the most bang for your buck. so i think whether it's manhattan project or just how do you work and innovate around it, introduce programs to maybe expand the way bart operates but then make certain it's getting utilized, that you're getting the most leverage out of every envaigs and when we look at the trade space in the countermeasures, you've got leadership issues. technologies that include information technologies, drugs, dog dig nosices, your behavior. if we focus only on the technology aspect without understanding how it gets through that gives better tools to leadership to make better decisions, gives better use of the risk and also gives you better results of your population, we've got to look at it all together and i think we tend to look at the technologies being the on answer but we have to look across that space. >> unless the post office has a part in this, i'm going to let you pass on this one. go ahead. >> i have a question for you about the post program. you were talking about the security concerns and the fact that the program is under -- i was at hrkhs, the postal union objected as mail carriers as dispensers because of the concern that they wanted a public safety officer assigned to each postal carrier, which struck me as an unrealistic request given our times in national emergency. so, how do you think the security concern can be handled and do you think there is a practical way of going forward? >> we've been dealing with this security question from day one. when this first came up. and the, the need for both health, safety, support in terms of preevent provisioning and the need for law enforcement experts on the street, those were original requirements. we went into each one of these five cities. in fact part of the grant process, those had come forward with the means to meet this security commitment and they did so. that's how they ended up receiving those grants and how they were able to afford in those five cities. it is a doable proposition. when you look at the number of law enforcement officers within a particular city and the number of carriers that we need on the street to effect delivery in the entirety of a city, even talking in some of these some of our cities that we went to, we covered the entire city. and we worked with them ahead of time to determine who can you put in place as far as security was concerned. so in order for us to have a plan in the first place in order to say that we had operational capableility. we had to have established that commitment with law enforcement so that was meant for those and we see the same thing going forward. if we were to reengage on this, which would take a certain amount of political push at this point. went into this because we were asked to come into it. pro to provide this last smile service, which we do really for the entirety of the country, whether it be -- so, we look at it as this is just a requirement that needs to be met in order for the safety and security of the people on the street. we also think it's just a good idea. if you're going to have it's better to have a team concept, someone out there paying attention to conditions on the ground and someone else who's paying attention in terms of the delivery function. >> where would this political push to reengage have to come from and how heavy of a push would it have to be? >> at this point in time i wouldn't want to put words in the mouth. >> one of the things we're referring to it's one thing to distribute in times, in normal time, but if there's a crisis in a community, we're going to use most of law enforcement for more traditional responsibilities, so it's one thing again, i'm fairly certain you'd be comfortable delivering, oral continue september contraceptives, i'm not sure, if it was in the middle of a crisis, something we have to address because there is no good answer. i mean, the bottom line is that the time of crisis it could be traditional responsibilities to law enforcement in helping you deliver a much needed vaccine that the population may not be their highest priority. >> ken. >> you mentioned that the decision was made to -- that it would only be a voluntary assignment and care yours could opt out and you already have for every house an every company in the country a human being assigned -- assigned to go deliver there and ideally say that person is going there and that person can then take the counter-measures to that house or that country in that time of need. if that carrier can opt out it seems like it defeats that purpose and my question is why was it made involuntarily? was it not a concern? >> we operate in a unionized environment and so it was not part of the collective bargaining agreement in that situation where you have a public health emergency where people are being asked to shelter in place and then go to a local point of dispensing and so being outside of those collective bargaining agreements the decision was made, can we approach the union and speak with them and talk about recruiting individuals to join the program and becoming participants of the program and that was why. >> and in the cities where you try to roll it out, how complicating has it been that people opt out? is that a problem? >> we went in and recruited. we recruited to whatever we could, whatever the maximum. we went shooting for a particular target in x number of postal routes we need to meet so we are taking on all participants in that regard. and through the recruitment process, we were able to provide for coverage based on the coverage area in the case of minneapolis, st. paul, had decided on. >> does the post person go to the door or put it in the mailbox? >> they are going to mail receptacles because that is the way our routing is based. >> right. i think this is part of an overall strategy i prefer the drug distribution in the united states because i think it is secure and it's -- it has an i.t. system that you can track it but part of an overall solution you can use a social security office, they probably have more people that show up there. >> and they know where to find it too. >> question for the doctor. you are highly educated deeply experienced, award-winning physician and scientist and you proposed repeatedly a paradigm shift in the way we develop vaccines and you say we have no traction and no one is responding to you positively. so i'm trying to understand why that is because it seems like it is a fairly straightforward scientific section. >> but she wants to do it without going through the long fda process. she wants the fda process -- we have to talk about safety. you want the fda process cut? >> i think the fda process can be revised. >> oh, it has been revised. you can do a fast track fda process. they did it for aids drugs. >> actually that is a great example. there are ways to look into the way to process the way it is been done now, can we find delivery. and with influenza viruses the trojan virus, we find the flavor of the moment. we can certainly do that for bio terror. so we are one of many companies proposing that but we have to rethink the way we approve the vaccines. and with all due respect for the animal rule the type of vaccines cannot be tested in animals because human responses are different. there are new models available that should be evaluated before -- >> so is the fda process the only impediment to your proposal? >> i think another significant impediment is the way the work is funded. we work through the system that has been cut dramatically in the last few years for reasons as people are well aware of and we had grants that had extremely good scores that were not funded, and even though -- for pathogens that were considered bio terror threats and we could not get funded because of the situation in place. that should be a priority. barta, which does a great job, cannot reach across the invisible line that separates it from the nih to grasp those interesting projects because they are considered r&d. maybe we should cut it off of proof of principal in animals and re-set the technical level of readiness and set projects that are innovative but not yet ready for the clinical trial because the companies like mine don't have the funding to get them to the clinical trial. >> thank you. >> panel do you have anything? all right. >> i was going to say that is a relatively easy thing to do. but it is easier than it should be. but that is something that can be part of the recommendation. >> it can be done. >> i've heard that rephrased many time. i want to talk about the flexible manufacturing. your testimony about vaccine on demand and clinical trials and you don't have the manufacturing capability and is it conceivable is that a venue or that the government should primarily fund to build a flexible manufacturing facility or venue that the small companies could use or big companies could use in response to a crisis. it is interesting that concept of flexible manufacturing, not only to the individual companies but to the broader community, particularly the entrepreneurs and let's face it most of the innovation comes from the small companies and that is the way it works in this country and to move this along do we need flexible venues to take advantage of what is out there. >> that is a great concept and it is not funded solely by the government. the private industry is funding part of it and the government is funding part of it and it is designed as you state. search capacity for developments in the clinic so we can scale them up and make them more readily avar able. that is the paradigm. there are three today. could they be expanded across the country. sure. part of the problem my colleague is experiencing is the paradigm she doesn't have the money and they are saying it is too high risk and how do we know the government will get behind this and so the paradigm is how do we get the companies like hers to get funding in partnership with nih with funding so these type of technologies can have a more appropriate, fair hearing and those are the types of things that i would respectfully submit should be priorities for the panel because if you want industry involvement -- and agree with your point about innovation being an industry, we need to figure out ways for this market to grow, to be sustained and to be viewed across large and small companies as a very attractive opportunity for business growth. >> i would just -- >> it is a fundamental question of what should government be doing and when does it profit share. and we are talking about vaccines in which the market is smaller than other kinds of drugs so it is a complicated question. >> well this applied broadly beyond bio-defense so i think vaccine are a good investment for various reasons and i would add to the wonderful comments from my colleague and what we need is this innovative step. so that is where we've been having trouble getting r&d to move forward. we also have been able to look at existing vaccines and say, wait a minute, we don't think this is a good idea. there should be a place for us to say that where it is going to be heard and there is no one i can talk to. my experience during h1n1 and n 19 is people don't want to hear that. people don't want to hear the vaccines they are going to make the vaccine we have today is the least effective vaccine ever made. we told you that in 2013 when the virus was published. >> when the virus was what -- >> when the virus was published. we published a paper saying the vaccine was a stealth virus and that new vaccines would be ineffective and less than ten months later we were proven right. >> any more questions? clearly you talked about inertia in government and we've been doing things the same way a long time and if you had intel related to a particular pathogen particularly nothing on the shelf to deal with, and what is the quickest way to design the components and test it quickly and get it out and the three to five year process is not going to work for that. the panel would be interested if you had specific recommendations with regards to companies dealing with nih and cdc we would love to see them because your type of companies are at the epi center and you have great new types of pharma companies and this panel would like to see both. >> i'm sympathetic but i want you to address the safety issues because the public will not tolerate particularly on widespread vaccines something that hasn't been appropriately tested. >> i think that that's going to be addressed. >> i'm not looking to shortcut safety measures. i think the whole process can be truncated. i think it is too long. >> i think when we are working with the tools, we have addressing safety and there are things we're learning about vaccines that we can improve the safety of existing vaccines. so we can hold the doors open to innovation while, as i agree with the secretary that safety will remain a very important issue. >> and it is still the number one priority. >> yes. >> we just think we can condense it? >> absolutely. >> we thank you very much. folks we are going to take a five minute break, not a ten-minute break, and we'll have the next panel up here by 3:00. >> thank you, ladies and gentlemen. our fourth panel involves recovery and mitigation and dr. burger, and michael hoff meyer from an conventional hoff meyer and dr. ken stanley cuply, former department assistant secretary and department of state for bio-defense policy and homeland security to defense for president bush. we are behind schedule but we won't truncate your opening remarks. >> can you define counter proliferation for me. >> sure. the way in which we prevent the -- [ inaudible ]. >> the easiest way to define counter proliferation would be to prevent the transit of illicit materials from one actor to another. >> okay. >> so first, thanks very much for the opportunity to -- >> what about nuclear arms in iran's hands? >> thank you very much for the opportunity to present here. i appreciate it. first, i would like to give a couple of framing remarks both on context and then how response and recovery i think are interrelated in the bio-event. so first as everyone here is aware, when outbreaks occur, whether they are natural or come from an intentional release can cause a massive loss of life and even when the loss of life is limited, of course diseases could effect a relatively large amount of people and economic loss and disruption. and even events on the other side of the globe can effect the homeland. i'll be speaking today in the context of recent events whether that is h 1 n 16, or mers or ebola. and the events today don't represent the worse case. but if the pathogens were more easily transmissible or more pathogenic, our response would have been more complex and substantial. and more words about the connection in my mind between response and recovery during a bio event. in the context of an infectious disease of a bio event where the illness spreads from community to community, some will reoccur and recovery in other communities and it can occur in the same breath. i think about rebuilding capacity in the system to the extent it's degraded and second establishing a new normal and third restoring public confidence and fourth reviewing and updating the response plans and activities you've put in place. so by way of saying all of that i think recovery in many ways is dependent upon the response that is undertaken and the intensity of the rebuilding effort and the efforts to restore public confidence in many ways depend on the response of your initial response. so in my remarks i want to underscore the importance of response which indicate recovery. i'll highlight what i've seen in best practices in three areas. first effective decision making and accountability. second capabilities required during response and recovery and third activities during recovery. and first, when you think about effective decision making during a response and recovery, two best practices to highlight for you, are first a clear articulation of accountability in terms of roles and responsibilities during the response and recovery phase of bio net and second exercises to practice and define decisions and execution. when we think about accountability we have made great strides. the original epidemic and pandemic act provided us with decision making and response but from my government service and since best practices indicate we could further articulate the lead individuals and agencies for health response during both domestic and international health kriess. when we think about things on the international stage we think about hhs and cdc and when we think about domestic responsibilities we think about the way in which dhs would play a much larger role. i think there is an opportunity to improve decision-making processes during these events. so i think the decision making process is very different than the business as usual decisions. in business as usual times, we have an element that addresses all concerns but during an emergency, you are much better off over time to come to a better out come eventually and i think there is an opportunity based on best practices to conduct additional drills and preparedness activities, particularly with the leadership involved in early decisions for both response and recovery in order to refine our ability to make those decisions because i think just from a -- from a certain organic perspective, decision-making like this doesn't come naturally to most institutions and the more we what can do to put that kind of decision-making at the fore the more powerfully we can respond to the events. the second thing i want to touk about is -- to talk about is the capability to mount a recovery. there are two emerging best practices to highlight here. first, the full time capability to respond to and recover from bio events. and second a strengthening of reserve capacities for surges in response and recovery. so when i think about response, i think about really three primary objectives. to find appropriate treatment for patients suffering from disease while minimizing the impact on the system over all and second is using epidemiological to stop the spread and third trying to contain. so limit the transmission based on the understanding of the disease or the event. there are four pertinent observations i'll make givens the objectives i've outlined. first, we have difficulty deploying resources to the field quickly. and many of you are aware of the recent piece by bill gates. he highlights the challenges during the ebola response to quickly recruit and deploy human resources to the field. the networks and the part-time responders that we've developed with a great deal of care were overwhelmed in our most recent crises. the second observation is the knowledge that you need, the types of expertise you need when you have, with increased scale of response, are increased. so with increased scale comes increased complexity and increased capabilities when you have a response like this. the third observation i would make is one i made at the outset as well. so we have recent examples of bio events both domestically and internationally but we should keep in mind what we may face in the future must be much more clear and complex. and the fourth point is there are many more responses of health over time and the scale of the responses have increases. so i'll go back to the two best practices then. i think we already -- we could consider additional full-time capabilities to the -- to be on call for a response during a medical event and that would include people like planners, lodgist ises and medical responders. i think we have made great strides in reserving capabilities. we could, when think about best practices, we could seek out on-call responders who can be trained on an interim basis with the skills necessary for those that are needed for a short notice for some extended period of time. the third area i'll peek about is -- i'll speak about is most explicit recovery. >> and i'm going to ask you to expedite. >> you got it. one of the recovery capabilities is updating plans and activities. so i'll confine my suggestion here to considering recovery in the context of replanning. so at the acute stage of any crisis you have the opportunity to actually take concrete steps to actually increase your level of preparedness. and i would just highlight that you can focus on planning equipping, training and then exercising in a much more concrete way at a best practice at the conclusion of the events. so i know that our time is short so i'll thank you very much for your time and -- >> any final conclusions in the area of recovery. just a couple of principles to share with us? >> no, i'll leave it there. >> thank you. please. >> thank you very much for inviting me to speak. i am going to focus on some of my remarks on science and technology advances that can enhance threat awareness and detection of biological events because both are central to risk and threat mitigation and recovery and both -- a key aspect of both is that advanced planning to minimize potential vulnerabilities in that prevention detection and response recovery pathway and maximize the key response resources such as medical counter measures and detection technology is extremely important. and so as part of my remarks, i will highlight some of the vulnerabilities but i want to have you think more about the whole system from prevention to response and mitigation to recovery. by way just of background, for the past five or six years i've been working closely with the fbi, especially agent ed yu who you had as a panelist last time and most recently we produced a product on national and transnational security data in the life sciences and that opened the doors to a lot of very interesting capabilities and problems that arise from biology relying on digital technology and how that might not only create risk but might help detect and help prevent the risk. and in addition to that, the work i've done in the middle east has been on risk mitigation and risk identification. and so it is from that perspective that i speak to you today. so the context in which all of this is occurring. you know very well about the public health emergency counter measure enterprise and the strategic stockpile and the issuance of several national strategies from counter threats to presidential directives on public health and the [ inaudible ] and regulations and now bio risk managements which is laboratory safety and security both in the united states and abroad and the global health security agenda launched last year which builds on the 2005 international health regulations and the u.s. government policy on bio surveillance. this is the system in which we are working when it comes to prevention and response. and new advances in science and technology are providing some really new, interesting opportunities to both detect incidents -- biological incidents early and mitigate risks before they transform into threats and respond to incidents through a variety of different means but three of which i'm going to speak to today -- about today. which is dig data -- big data anna listityics and cloud base and capabilities. whether the threat is an if actor expressed interest in carrying out a terrorist act whether or not they are using biological agents or the threat is an outbreak or accidental release of a harmful pathogen. and they also provide insight into detection or characterization of in infectious disease that would develop -- development and model of decontamination strategies to facilitate response and recovery. so big data analytics, what is it? it is the analysis of data generated and collected from a number of distinct sources and from more than one data set at a rapid speed and at rapid different times. it is large in volume but not necessarily individual pieces being large and has a high degree of uncertainty. the data can be deliberately deposited into daisa bases such as genome or internet search terms and purchasing preferences. it can be born such as search data or converted from observation to digital information such as data published in scientific literature. it can be using a number of different technologies all of which government and other technologies are investing in. these are data mining speech image recognition, social media analysis and mathematical statistic analysis. i want to provide two examples of how big data has actually played a role already in the prevention and detection of sort of the biological threat. so one example is the global terrorism data base which uses social media to provide a picture of which actors pose a threat and which individuals and groups have expressed interest in using biological agents as a means to cause harm and with this knowledge security officials can be better equipped to determine whether certain nonstate actors are acquiring the expertise materials to carry out an attack. with the biological agent or to employee strategy that minimize the likelihood that an attack will be successful. and another example is health maps, and news outlets clinical data bases to depect potential ly outbreaks. and an outbreak -- it is important when doing response activities. and with these early warnings, security officials can employ measures to both control the current outbreak and prevent further infection and disruption. this is not the only program that does this. there are several different networks that try and build on some of the large data sets and different sources of data. examples include the global public health intelligence network, the global outbreak and response network which is part of who, google flu friends and denga trends sand agent studies which is something nih supports. all of this is to say that forecasting and prediction of an outbreak is catching on and i saw a paper about two days ago that said that china wants -- or china has described the benefits of using data analytics. so this is not just a u.s. or w.h.o. thing. so another sub-example of this is 2013 the cdc launched a predict the influenza challenge which was for flu prediction and they used as a data set the 2013-2014 flu season. so looking to the future where can the technology add to our capability to detect the threat early and to mitigate it or respond to it. several examples include forensic analysis and attribution and identifying broadly acting counter measures determining whether function of biological components with be determined through sequence analysis and evaluating the damage of an actual biological incident identifying possible discrepancies in confidence-building measures at the convention predicting malicious information from a broad set of information or evaluating the lessons learned from natural or man-made events. but despite the potential events, big data analytics is vulnerable because it depends on compute systems an daisa bases and so -- data bases so vulnerable to hacking and exploitation. over the last decade it is no surprise that computer systems and data bases are prime targets for hackers and nonstate actors. the u.s. is concerned about protecting critical infrastructure through cyber attack and that is a conversation we've had for many years. people's personal -- the public is concerned about protection of their personal information and privacy because of hacking of health care networks and being able to identify people and i just sort of want to point out in the last -- i think the last six to nine months three individual hacking events of health systems or information has occurred in 2014, the health organization was attacked and in 2014 anthem, 79 million records were released and prime era was attacked and that was 11 million records and it included medical records. so this is a pretty big problem. and combine that with having patient genomic information part of the medical records, the situation, some can get beyond the individual problem. several technologies do exist to prevent unauthorized users to gaining access to the computer system, yet nonstate actors and states are still conducting cyber attacks to disrupt computer systems and spying. as you know last year, the president's counsel of advisers of science and technology issued recommendations on technology to protect vulnerability and enhance privacy and we've had for many years huge investment in cyber and work horse and response and yet the u.s. is not well structured to address science and technology sectors where the insult is in the cyber realm and the output is in the release of biological outputs or theft of proprietary information about counter measures in which the u.s. is investing. >> i'll have to ask you -- we'll get to your testimony. if you could draw conclusions. we'll more interested in the q&a. >> sure. i won't go into the 3-d printing or the -- but i want to quickly talk about cloud-based sharing. in 2011 we were able to, as a global scientific community, identify a 2011 e-coli outbreak in germany and france as one that was natural and not man-made just by -- within 12 hours by sequences being posted on the cloud and scientists being able to download that and sequence it and do analysis on it and it's through the cloud-sharing and the cloud-based analytics that we were able to do that. so those are all capabilities but we do come with vulnerability and the conclusion i would leave you with is we need to think more strategically about the cross-domain threats and the multi disciplinary threats they offer and that we are not really well set up to be able to look at the risk and the benefit compare the risk and the benefit that is risk and benefits. >> we'll talk about that cod based information when we get back to you. sir. >> thank you. in the interest of time, i'll limit my remarked with two points. >> we'll intrigued with unconventional concepts so we're all ears. >> so i'll do my best to keep you entertained. first, refrain through bio-defense or any unconventional threat or incident if you will, the requirements, resources, training skills, capabilities needed to respond. perfectly justifiable and reasonable. but i think we miss a key question in this. which is more importantly, what is the best that we can do with what we already have. almost, without exception any event and occurrence we have we have a long list of required materials, oftentimes funding needed to prepare for that incident whether it is response mitigation or any aspect, however, almost equally without exception, we never have all of those materials. we very seldom meet all of the requirements we have. in fact arguable will youe ablable -- arguably never. and we almost never meet the requirements. but the question is how do we optimize the use of the resources and capabilities that we actually do have. that tends to lack in prepared preparedness and planning and the entire spectrum of response to an incident. for example, very few people are aware that in the realm of response for veterinary medicine, those drugs are almost identical to those used for human beings. they are manufactured in the same plants for human beings. they are packaged differently. the dosage for a five or six pound cat for a bull is different for a human being but the drugs in and of themselves are the same but i have never seen a plan that looks at reaching out to leverage the pharmaceutical supplies for the agricultural arena to make up the short comings in a human event. so the first point i would leave you with is that while i do not advocate replacing the list of requirements that we need, frankly that provides money and resources, jobs and other things, we need to also add to these key questions and this key base of how to optimize the use of the resources that we have. given we have nothing more what is the best we can do. the second issue equally important is there tends to be not unjustifiably so there is a focus on the professional responder and response community. again, incredibly important. but to put things in context depending on how you put together the numbers, there is 1.5 million, to 2 million maybe 2.5 million first responders, police, fire and medical related resources. under the best of resources that is one first responders and we look at how do we empower the people to care for themselves. and it goes well beyond public service announcements. an excellent example in my mind is the aed or automatic external defibrillatored. it used to require a trained nurse and a cardyologist or an emergency room to provide the care but as a result we lowered that barrier and if you are bright enough to operate a fire extinguisher you can defip ril ate somebody. and the response first started in california and as many things have done, it is based on the fact that the true first responder is very seldom the trained professional. in the case of this room today, if any of us had a heart attack or would choke, the first responder would not be an emtor police officer it would be the person sitting next to that person. and whether we like it or not, the population will care for itself. it may not do a particularly good job, but that is a failing on the part of policy makers for not preparing for that realistically and the short coming there is we continue to try and focus again reasonably on the professional responder but we lose sight of the opportunity to truly empower the public and that can we done through two basic means. one, training educating and improving the capabilities of the public organically to care for and provide its own support and two using the benefits and powers of science and technology to lower the barrier of entry to provide care. it does not require a physician for example, to diagnose a case of ebola in west africa, when you come in you are bleeding and coughing and running a fever. at that point you have a presumptive diagnosis. there, how can i train the people to provide a greater level of care, somewhat analogous of what we do in the fire fighting community. when we have large fires out of control, we don't train firefighters. we get a random unit from the military and we have training and equipment in three to five hours we can train personnel one, not to kill those around them and themselves but we haven't been able to take it to the public to provide care and support to themselves in a bio defense arena. and with that gentlemen and ma'am, i'm done. >> very good. thank you. thank you. we'll start with dr. alexander. >> thank you very much. you answered some of my initial questions. how to optimize the efforts to reduce the risks. for example, should we expand the security culture in terms of training the individual i think you mentioned so empower the people people. that is one area. what concerns me is looking at the terrorist and their intentions and what they are planning to do there is no end to their evil intentions. for example, can we provide better accounting for some of the bio-materials similar to the way we try to follow the money on the financing area or should we for example strengthen surveillance and detection or should we strengthen the bio nonproliferation you are working on, the bio weapons conventions. so in other words there are a series of questions inter-related in order to try to bring down the risk level. if you could respond to that? >> yes, sir. first, i would note there is a term in the military a robust defense in depth, which is looking at a variety of factors all integrated to function together as a system. all of the points that you made and many more, i think can be strengthened and through information-sharing can improve our capability to protect against them. but that is one half of the problem. the other half, regardless of what the cause of the bio incident is, a natural emerging disease or an intentional release of an agent i think there are a number of things that the population itself can do to detect early that there is an event and an anomalous event and reduce the spread of that event. and many are nonmedical counter measures that don't require a structure for vaccines and drugs and don't require logistics to distribute them or training to make them available and usable. the example i gave earlier, an aed used to be purely the area of a trained medical professional and because of technology improvements, rather than trying to make the effort to train the public how to use it, we accepted the fact that the public, from a pragmatic point of view, isn't going to learn. regardless of the reason they simply won't, so taking that as a boundary, new technologies were developed to deal with that as a real-world condition. does that answer your question? >> yes. thank you. >> advisory panel? i'll refer to my colleagues up here. gentlemen? >> i would like to follow up. your thoughts about empowering the people. in the biotech context, what would be the actions that you want the people to be prepared to do. when you think about the '50s and the fallout shelters and the duct tape and doug still probably gets them in his christmas stocking every year, and we've seen these things -- i love the idea. i'm enamored with the idea of professionalized the populous, but what specific things would you train them or us to do? >> i can give you an example. i was on the staff with dr. carmona when he was u.s. surgeon general. we talked about standard of care versus appropriate care and developed a phase change in population care or population health maintenance. but let us assume for the sake of discussion that the brownies we had here today had cholera in them and five or ten people come down with it and not saying that we have. but each one of the people would end up in an icu welcome back the next two to three days and have ten to 12 medical professionals caring for them and every professional doc would come and look at them being miserable. if you had 10 -- 20 -- cholera is very unpleasant. not from personal experience i assure you. if you had 20 to 30 people we would scale up and clear out icu's and do the same thing. if we had 5,000 cases, you couldn't do it. you would have a fundamental transition where the population would be told here is how you make a cholera bed so to keep you well hydrated and take anti-biotics and basic treatment and where i've had training por the population to care for its own people. that does not work for every case but works in many cases with we start with the underlying tennant that i'm not having everybody report to a hospital but what are the basic skills an training and the basic capabilities that the population needs to provide for itself that may not meet the standard of care but in an environment like that meet the standard of sufficient or appropriate care. does that make sense? >> yeah. i'm struggling with what specific things you do. i think the things in the past were all advise ability -- advisable. but they did not get traction. and it is not clear whether there is that much that can be done medically by lay persons in the bio or chem attacks. >> in that environment, i don't necessarily disagree. as i mentioned we have aed's and that is for a specific malady, but if you look across the board. it is the a.b.c.'s, airway, breathing and -- circulation, thank you. and those are the basic things that have to be maintained. through a combination of technology and preparedness to allow people to be supported and supported by those around them and nearby, you don't necessarily need professional medical care or medical care at all but it has to be not a model of how do i train the population to do it but the other half of the problem is how do i prepare technology and infrastructure and the basic expectation they will have to do it and enable them to do it. so a different point of view. >> i have a question. jim greenwood, please. >> i don't know if you answer this or not, but having the public as informed and as empowered only. this is only a test, if this was a real emergency, we would have told you what to do. and it is making me wonder whether -- whoever that is actually knows what to do. [ laughter ] and in these type of events. >> that is an excellent point. i've lectured and taught on crisis points in the past. when i've lectured on it and i believe most training for crisis is wrong. we try to tell the population what the quote, right thing to do is. we go into that knowing full well that frankly most people are either going to screw it up or do something intentionally different. katrina is a great example. evacuate, some people stayed home and some people went to the superdome. the proper thing to communicate to the population is to try and get the most people to do something predictable. and the reason for that is, if they are doing something that is predictable, i can now plan for that. i cannot plan for chaos. there is the old song 20% of the population requires 80% of the resources. it is probably a little farther along than that. it is something definite, and assuming we know what the right thing is and frequently we doan. and it is trying to get as many people to do something predictable as possible so we can respond to that. again, the superdome and in katrina, we would have had water there and encouraged people, rather than if you can't evacuate, go here and we'll have supplied. instead we have the worst situation. the population showed up where we weren't prepared for. and well more than 10,000 were scattered over thousands of square miles and had to be addressed individually. >> and i'm sorry. my question and maybe you don't know if there were a biological terror attack in washington, d.c. now, and all of a sudden our televisions and radios started saying beep beep, we've had an attack, do you have an idea as to whether the advice coming forward after that beep is the right information? >> it is highly scenario-dependent. i go back to anthrax and a former secretary of health and human services who indicated that the first case of anthrax was accidental from drinking contaminated water. >> it wasn't me. >> no. [ laughter ] >> it was highly dependent on the situation and the individual and frankly in many cases we may not know. >> dr. burger you had a comment to make. share it with us. >> so i just wanted to make two comments. one, is there is a recent push in a public engagement on a wide range of public topics and this is a prime topic to engage with people, particularly if you start with measles and disney world or disneyland and you walk away from that to something more unpredictable like a bio terror attack and how you would prepare your families and workplace and so on. the other thing is that i do believe we'll get some of the predictability by the mobile health and smart health apps that we now have on phones and watches and all sorts of gadgets all over the place, as well as internet of things, as more and more of our lives go somewhere in data bases. we have a better ability to predict what people are doing so that is a good thing and a bad thing. but in terms of being able to plan what are people -- what are people doing at different times of the day, how might they react if they see an alert on their watch that says your temperature has just increased by so many or whatever -- these technologies are being developed and they are being used in all sorts of mobile applications and smart devices and that is something we should think about harnessing. >> doctor staley. >> thanks. to build on the comments you've been made. i think when we think about recovery, we are think being a way in which we are rebuilding our capacity, right. so if you think about a continuum of supply and demand, we have a set supply of medical -- the ability to deliver medical measures to a population and depending on the severity of the event if we have our build over time we have the ability of cape asity over time. but we have the levels to take on care that would otherwise be taken care of in a more professional setting. when you think about the tools you have to enhance recovery, i think on one end of the spectrum when you think about a severe incident when the capabilities are overwhelmed, you need to think about empowering inging individuals as we've discussed already. and on the other side you can think about attempts we can take now for recovery. and a great example of what is going on now and can we expanded over time is the immediate bed availability program that the hospitals are doing. so they've looked at challenges we might have during a major medical event and said, we want to try to find a way that hospitals could release 20% of their patients within four hours to have the ability to surge patients from an emergency to that system. so they worked as a process of planning and drilling and they worked to find processes that can quickly on an ongoing basis find the patients in the system and find ways to off-load the patients using a reversed -- a reversed triage system and upload patients from an existing emergency. so i think when you think about ways to impact recovery, you are looking at a spectrum of tools. part of it is thinking at the very extreme end again about empowering individuals. on the other side i do think it comes down to a deliberate process, a preparedness process that heaps you -- helps your institutions become more resilient. >> i have a quick question from dr. burger i want to point out as university president, i'm not worried about cholera in brownies -- >> not on campus. >> dr. burger you have done a lot creating table top exercises and that's been used for a long time and what are the benefits of table top exercises versus the new apps and other types of things? >> so they are inherently different. >> yes. right. >> we have -- so the biggest limitation that we've always encountered with table top exercises is people come with their preconceived notions and that is how they play and it is hard to get people to think about what is the role of -- some other function and how do i fit with that other function in my daily life. and so developing the exercises and facilitating the exercises out of their own skin and into somebody else's to see how you would interact with different functions and how they relate to your own is really important. the mobile devices that is a fascinating thing to see -- to watch happen. it is fascinating to me to see how much information is collected and it is fascinating for me to sort of think about where is that going and how is that information going to be used in any sort of decision-making capacity from an individual health perspective to a community health perspective to even a national health perspective. so when we think about how do we take all of the information that we have available to us from all sorts of different sources and provide that in a way to decision-makers to say this is an issue and this is the location of the issue and that is what you need to do to deal with that issue in a real tangible meaningful way we are still away from that. but certainly the tools are being developed to try and do that. >> okay. yes. >> go ahead. >> can i ask ken for just a second. just to follow on the point about exercises. you mentioned concerns you have on decision making process and crisises in the response and gave us a teaser that there are best practices that can be disseminated and best practices but can you put more meat on the bones and can you explain how the response can be better than it is now. >> sure. to take it from a best practice program, in my awareness of how of the structure is now is opaque. if you think about the process that brought people together to put them around the table to discuss a buyio event you want to take a process like that and have leaders put into drilling situations where they can make decisions with imperfect information and the way in which they would commit resources. i think in order to be moreective, you -- more effective, you want to make that part of the comprehensive preparedness program as part of the best practice. so think about the different types of threats you are worried about and the different types of capabilities you want to exercise and leaders to be able to have at their disposal and then test those over time. >> so you are the advocates of more exercise. >> yes. >> i agree with you. >> dr. burger, you identified the big data to inform us from gio location to the the very appropriate use of technology to inform us from geo location to type of potential pathogen out there. i think you used an example in germany. was it e. coli? >> yes. i sort of described that in terms of cloud herring. in 2011 hundreds of people got ill from e. coli infection. cases in france somewhat sporadic. turns out causes were natural, came from seeds from egypt. but the interesting piece of this was a chinese company bgi sequenced, threw it on the cloud, german scientists able to do analysis very quickly and look how they are related to other related bacteria and could say it was natural not man made made. that situational awareness with law enforcement so on so forth. >> thank you for clarifying that. that was very helpful. anybody else on the advisory board? yes, sir. >> i think somehow pulling all this toregether, it comes back to letting more people be involved in this effort by defense. i think chinese pulled e. coli out because they wanted to be the fastest to do that. some other people never involved in that world got to play with it. like you're saying let the public. i think part of our leadership challenge is defense, you know, like a secret thing and only we can do it or is it a societal thing and we engage everybody and get the public engaged and kind of belief most americans want to do good things. how do we take advantage of that is what you're saying too. how do you get more people engaged in these things. the last meeting maybe people can have doxacicline or cipro, engage them, hour them. long-term has to go back to early childhood education. we start teaching people about awareness and health and how to help society. >> i think there's an important nuance there. it's not a question of letting people be involved. people will do something. heard of cattle is going to go forward whether you want them to or not. not that people are cattle -- had to clarify that -- they will be involved and want to do something. the question is do we give them information to do something less bad than they would have lacking that information? >> so i would actually like to make two quick points, we we take into account aspects of how we reach out to different people. we're such a diverse culture of people that we need to be able to first and foremost say we respect you and respect where you come from and then go from there. that's sort of what the public engagement and science efforts start doing now is to start with that as a premise. the second piece of it is that there are actually board games and apps now that allow people to play role-playing games where you get to save the world from a pathogen of some sort. that in and of itself may be make way of sensitizing people to thinking about how you would deal with certain issues in bioterrorism. it's just something to think about. >> any further comments? >> no. >> we thank you very much for your contribution. we very much appreciate your testimony. got prepared in march, hope leaving with the team, like to go over them. after you've left, we'll go over them. >> thank you very much. >> you bet. tonight on c-span a week long series on congressional freshman starting with republican steve russell of oklahoma. he talks about his career in the army, new life in congress and childhood experience. a different profile each night at 9:00 eastern. with congress on break, it's american history tv in prime time starting at 8:00 eastern with daniel ellsberg who become consultant to the defense department on matters concerning vietnam war. he talks about his motivation leaking pentagon papers and his opinions on vietnam. that wouldish followed by interview, followed by counsel to the president. he talks about his early assignments, watergate and people behind the 1972 break-in at headquarters. american tv prime time tonight and all this week starting at 8:00 eastern here on c-span3. >> tonight on the communicators author vincent moscow on cloud storage and big data and how the government is using it. >> national security agency is building one of the world's largest clouds data centers in a secure mountain facility in utah. it's doing so because it's surveillance needs require that degree of storage and security. the u.s. government's chief information officer three or for years ago ordered u.s. government agencies to move to the cloud. and as a result even civilian agencies are turning to cloud services. >> tonight at 8:00 eastern on the communicators on c-span 2. >> we return to blue ribbon panel in washington, d.c. examining leadership and organizational structures needed to effectively address biological and chemical threats. this is just under an hour. >> the final panel of this fourth day of public testimony we hope will -- we think is going to deal with an issue we wrestled with every time we've had a public meeting and that's the question of leadership and organizational structure. there's a lot of organizations and individuals to play in biodefense, multiple jurisdictions, private sector. a very experienced panel appropriately concludes the final day of this public testimony. i'd like to introduce, ken bernard with president bush, former senior adviser to president bill clinton for security and health. rear admirable, admirable admiral admiral. retired u.s. health service. bob, you weren't here but we already cloned you. so many people talked about the work before, deputy staff director for united states select committee on intelligence former special assistant to president bush for health and defense retired air force i would say at the epicenter for bioterrorism discussions in both administrations. i'm most familiar with the work he did when i had the privilege of serving with president bush. also lisa gordon-haggerty, security council for president bush and president clinton. a week after i got to the white house we had the first anthrax and i had to deal with her and her team how we deal publicly. we experienced in the first couple of weeks a lot of concerns that have been addressed by previous testimony not just today but in the three panels. how do you coordinate an efficient response in order to deal with that crisis. so we kkz the panelists and ladies first. >> thank you. good afternoon, everyone. thank you for the privilege to speak before this important panel today. i certainly support your mission and given my prior experience i'm hopeful my opinions will serve the purpose. i'm also grateful to be in the company of my two dear friends with whom i share much in common and work towards fixing endless battle of interagency coordination but most importantly leadership. my perspective comes from having served as career civil servant once again department of energy director for technical response to all nuclear and radiological emergencies. after a few years i moved to the white house for weapons of mass destruction preparedness prior to and after 911 serving two administrations. therefore i hope to offer interagency and white house perspective of what should have been accomplished many years ago but what i believe can still be accomplished now for the future. finally in the event my opinions might serve to be dated i've been fortunately part of serving more than three years as the national academy's institute of medicine standing committee on health threats resilience, workforce resilience national security department of health affairs whose focus has been biothreat preparedness, response and recovery. i also work for small business whose primary focus on interagency disciplinary support for state and local responders for ieds, shooters and weapons of mass destruction. when i began participating in the 1990s through interagency process known as then classified coordinating subgroup known as counter-terrorism security group supported national policy combatin

Northeast High School alumni upset after trophies trashed

After an uproar about trophies from Lincoln Northeast being discarded in a dumpster over the weekend, Lincoln Public Schools said it will change its policy about old school memorabilia.

Janet Garrett, elected as a write-in, takes oath for Oberlin Schools Board of Education

The Oberlin School District Board of Education held an organizational meeting Jan. 9 at Oberlin Elementary School and voted on the president and vice president roles and swore in two recently elected members, including one who ran a write-in campaign and won. The board re-elected Farah Emeka as president and re-elected Jo-Anne Steggall as vice […]

Shoebox Living? - New Planning Guidelines Will See Apartments Get A LOT Smaller

England World Cup win 1966: Menston author explores truth and mythology in Sir Alf Ramsey's team

night of the big heat film locations

modl.ai closes €8.5m Funding for AI Engine to Unleash Bots and Transform Game Development

The funding round was led by Griffin Gaming Partners, one of the world's largest venture funds focusing exclusively on gaming and Microsoft's Venture Fund M12 modl.ai, which seeks to remove the

Chess, Schema-Root news

Cross-linked news, and information resources about Chess

Warm Weather Brings More than Thousand Through Tommy's Car Wash