Lawmakers question bioterror readiness of public health system

Members of a House Government Reform subcommittee on Monday expressed their concern that while the country's public health system has come a long way in preparing for a bioterrorist attack, it still has a long way to go.

Subcommittee members repeatedly queried panelists, including Dr. David Fleming-the deputy director for public health science at the Centers for Disease Control and Prevention in Atlanta-about whether legislation might be necessary to establish a clear chain of command in the event of a bioterrorist attack. They also asked whether legislation was needed to ensure that the CDC makes progress in implementing a nationwide system for public health officials to report suspicious diagnoses and symptoms.

The Subcommittee on National Security, Emerging Threats and International Relations, headed by Rep. Christopher Shays, R-Conn., heard testimony from Fleming and Dr. David Tornberg, the deputy assistant secretary of Defense for Clinical and Program policy, as well as local public health officials.

Fleming tried to allay the panel's concerns, arguing that the current public health system is not broken, and usually does a good job at detecting disease outbreaks. He painted a picture of a state-based system where state public health officials collect information on diagnoses and reports on symptoms from health care providers. State public health officials then report the information to the CDC.

But Fleming admitted that a bioterrorist attack might prove more than the current system could handle. The current "largely paper-based system is burdensome both to [healthcare] providers and health departments, often resulting in reports which are not complete or timely," he said. In addition, he added, the "volume of paper reports and the need to enter the information collected into various systems leads to errors and duplication of efforts."

To help correct the problem, Fleming said the CDC is developing the National Electronic Disease Surveillance System. That system will ensure that local public health departments are able to provide the CDC with timely, computerized reports on diagnoses and symptoms. The CDC is allowing states to either use CDC-developed software, or to create their own compatible systems. Currently, 30 states have requested installation of the CDC system, while 20 are developing their own software.

Tornberg said that the Defense Department's Essence system, or Electronic Surveillance System for the Early Notification of Community-based Epidemics, offers hope that a nationwide system could succeed. Implemented in 1999, the Essence system aims to catch an outbreak of disease in the Washington area. It collects diagnoses at 100 Defense clinics within 50 miles of the White House each day.

Members of the House subcommittee, however, repeatedly asked witnesses about what they could do to help get the national reporting system up and running more quickly. They also debated whether legislation mandating progress might prompt a quicker turnaround at CDC. "I think [the current public health system] is far worse than some of our colleagues at CDC think it is," said Rep. Bill Janklow, R-S.D.

Rep. Chris Bell, D-Texas, also expressed concern that the Bush administration has proposed a flat budget for CDC, and asked Fleming whether the agency has enough funds to implement the national disease surveillance system. Fleming said the CDC was currently working with the Office of Management and Budget to determine how much it will cost to put the system in place.