HHS effort to consolidate operations met with skepticism

Participants in a Senate hearing Thursday questioned whether consolidating several public affairs offices within the Health and Human Services Department would improve communication on bioterrorism between the government and the public.

As part of its "One Department" initiative to streamline operations, HHS is consolidating a number of management functions, including centralizing more than 50 public affairs offices under the Office of the Secretary. Consolidating the department's disparate public affairs offices will help HHS "speak with one voice" on important public health issues, such as bioterrorism, said Secretary Tommy Thompson at a hearing before the Senate Governmental Affairs Committee.

But the initiative could "have the undesirable and unintended effect of slowing the movement of information from public health experts in the federal government to their state and local counterparts, to the public and to the public's representatives in Congress," said Sen. Max Cleland, D-Ga.

A former HHS official said it would be "unrealistic" to think each agency's public affairs office could efficiently report directly to the Office of the Secretary. "This would neither be logistically feasible or desirable with respect to assuring the communication of often highly technical information in an accurate and efficient manner to others outside the department," said Dr. Margaret Hamburg, vice president for biological programs at the Nuclear Threat Initiative, a nonprofit organization working to reduce the threat of weapons of mass destruction.

Six different HHS agencies, including the National Institutes of Health and the Centers for Disease Control and Prevention, operate anti-bioterrorism programs. At NIH alone, 27 different institutes and centers each have their own communications staff.

HHS and other agencies came under fire last fall from lawmakers, members of the medical community and the public for failing to provide credible health information during the anthrax outbreak. "As the management of the anthrax episodes demonstrated, it is generally a mistake to put too much distance between official spokespeople and the subject matter expertise," Hamburg said.

Thompson said streamlining the department's public affairs functions would help, not hurt, communication, particularly in a crisis. "While public affairs and legislative functions will be consolidated in the Office of the Secretary, staff associated with these functions will continue to work in the programs in which they have expertise," Thompson said. "The goal is to create a cohesive structure that supports the development and execution of clear, timely and fact-based communication with Congress and the public." The "One Department" initiative also consolidates more than 20 HHS legislative offices.

"I want to make sure that whatever is going on with the department's agencies is coordinated through the department's Office of Public Health Preparedness," Thompson said. "We want to speak with one voice, and coordinate the message quickly."

In the event of a bioterrorist attack, the head of the newly created Office of Public Health Preparedness in the HHS secretary's office would act as the government's spokesman on public health matters, Thompson said. Dr. Donald Henderson, a former CDC official who led the campaign to eradicate smallpox in the United States, is the current head of the Office of Public Health Preparedness.

Last fall, a panel of doctors, including former Surgeon General C. Everett Koop, called on the government to appoint a spokesman with a medical background to provide credible health information on bioterrorism to avoid the confusion created during the anthrax outbreak.

Members of state and local medical communities would continue to receive information on public health issues related to bioterrorism directly from the CDC, Thompson said. The consolidation plan for public affairs and legislative offices aims primarily to improve communication between HHS and the public, and between HHS and Congress, he said. During the anthrax outbreak, the CDC posted daily news updates on its Web site.

The administration plans to award more than $1 billion to states this year to help them develop their anti-bioterrorism plans and revamp their laboratories and communication systems. Some of the funds will go to upgrading the Health Alert Network, the CDC's electronic communications system that provides Internet access to state and local public health departments. The fiscal 2003 budget proposes $4.3 billion for the Health and Human Services Department for bioterrorism preparedness programs, a 45 percent increase from the fiscal 2002 budget.

Senate Governmental Affairs Committee Chairman Joseph Lieberman, D-Conn., asked Thompson to rate, on a scale of one to 10, how well the government is prepared to handle an attack involving bioterrorism.

"Once we distribute all the money, I would say six, going on seven," Thompson said.