S. HRG. 110–341 PANDEMIC INFLUENZA: PROGRESS MADE AND CHALLENGES AHEAD HEARING BEFORE A SUBCOMMITTEE OF THE COMMITTEE ON APPROPRIATIONS UNITED STATES SENATE ONE HUNDRED TENTH CONGRESS FIRST SESSION SPECIAL HEARING JANUARY 24, 2007—WASHINGTON, DC Printed for the use of the Committee on Appropriations ( Available via the World Wide Web: http://www.gpoaccess.gov/congress/index.html U.S. GOVERNMENT PRINTING OFFICE 41–637 PDF WASHINGTON : 2008 For sale by the Superintendent of Documents, U.S. Government Printing Office Internet: bookstore.gpo.gov Phone: toll free (866) 512–1800; DC area (202) 512–1800 Fax: (202) 512–2250 Mail: Stop SSOP, Washington, DC 20402–0001 COMMITTEE ON APPROPRIATIONS ROBERT C. BYRD, West Virginia, Chairman DANIEL K. INOUYE, Hawaii THAD COCHRAN, Mississippi PATRICK J. LEAHY, Vermont TED STEVENS, Alaska TOM HARKIN, Iowa ARLEN SPECTER, Pennsylvania BARBARA A. MIKULSKI, Maryland PETE V. DOMENICI, New Mexico HERB KOHL, Wisconsin CHRISTOPHER S. BOND, Missouri PATTY MURRAY, Washington MITCH MCCONNELL, Kentucky BYRON L. DORGAN, North Dakota RICHARD C. SHELBY, Alabama DIANNE FEINSTEIN, California JUDD GREGG, New Hampshire RICHARD J. DURBIN, Illinois ROBERT F. BENNETT, Utah TIM JOHNSON, South Dakota LARRY CRAIG, Idaho MARY L. LANDRIEU, Louisiana KAY BAILEY HUTCHISON, Texas JACK REED, Rhode Island SAM BROWNBACK, Kansas FRANK R. LAUTENBERG, New Jersey WAYNE ALLARD, Colorado BEN NELSON, Nebraska LAMAR ALEXANDER, Tennessee CHARLES KIEFFER, Staff Director BRUCE EVANS, Minority Staff Director SUBCOMMITTEE ON DEPARTMENTS OF LABOR, HEALTH AND HUMAN SERVICES, AND EDUCATION, AND RELATED AGENCIES TOM HARKIN, Iowa, Chairman DANIEL K. INOUYE, Hawaii ARLEN SPECTER, Pennsylvania HERB KOHL, Wisconsin THAD COCHRAN, Mississippi PATTY MURRAY, Washington JUDD GREGG, New Hampshire MARY L. LANDRIEU, Louisiana LARRY CRAIG, Idaho RICHARD J. DURBIN, Illinois KAY BAILEY HUTCHISON, Texas JACK REED, Rhode Island TED STEVENS, Alaska FRANK R. LAUTENBERG, New Jersey RICHARD C. SHELBY, Alabama Professional Staff ELLEN MURRAY ERIK FATEMI MARK LAISCH ADRIENNE HALLETT LISA BERNHARDT BETTILOU TAYLOR (Minority) SUDIP SHRIKANT PARIKH (Minority) Administrative Support TERI CURTIN JEFF KRATZ (Minority) (II) CONTENTS Page Opening statement of Senator Arlen Specter ........................................................ 1 Opening statement of Senator Tom Harkin .......................................................... 2 Prepared statement .......................................................................................... 3 Statement of Dr. Gerald W. Parker, D.V.M., Ph.D. Principal Deputy Assistant Secretary, Office of the Assistant Secretary for Preparedness and Response, Department of Health and Human Services ...................................................... 5 Prepared statement .......................................................................................... 7 Statement of Dr. Julie L. Gerberding, M.D., Director, Centers for Disease Control and Prevention, Department of Health and Human Services ............ 14 Prepared statement .......................................................................................... 16 Statement of Dr. Anthony S. Fauci, M.D., Director, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Department of Health and Human Services ........................................................................... 25 Prepared statement .......................................................................................... 27 Statement of Dr. John Jay Treanor, M.D., director, Vaccine Treatment and Evaluation Unit, University of Rochester Medical Center ............................... 32 Prepared statement .......................................................................................... 34 (III) PANDEMIC INFLUENZA: PROGRESS MADE AND CHALLENGES AHEAD WEDNESDAY, JANUARY 24, 2007 U.S. SENATE, SUBCOMMITTEE ON LABOR, HEALTH AND HUMAN SERVICES, AND EDUCATION, AND RELATED AGENCIES, COMMITTEE ON APPROPRIATIONS, Washington, DC. The subcommittee met at 9:50 a.m., in room SD–124, Dirksen Senate Office Building, Hon. Tom Harkin (chairman) presiding. Present: Senators Harkin, Reed, Durbin, and Specter. OPENING STATEMENT OF SENATOR ARLEN SPECTER Senator SPECTER. Good morning, ladies and gentlemen. On a conspiracy, secret conspiracy, which is about to be made public, the chairman and I have been conferring and he handed me the gavel so that we could have a ceremonial shift in gavel. Senator Harkin and I, who have traded positions as the powers have flowed, have always talked about it being a seamless change in the gavel. So I want to express my appreciation to Senator Har- kin for handing me the gavel and to announce publicly that I’m not going to give it back. But on a serious level, it doesn’t happen too often in the Senate, Tom Harkin and Arlen Specter have worked very closely together for more than two decades, since Senator Harkin was elected in 1984, and I think that has benefited the American people and the health community and the education community and worker safety and labor, where those three departments are under the funding of this subcommittee. In a contentious political climate in Wash- ington, this is we think the way it ought to be operated. So here comes the seamless transfer, Mr. Chairman. Senator HARKIN. Well, thank you. Thank you, Arlen, very much. Let me thank my friend and colleague for his kind words, and for 22 years of very close cooperation and a great working relationship. It has been, I was just counting up, this is the fourth time, Arlen, that this thing has gone back and forth between us, and it has been great working together. Even our staffs, I mean, I think if I’m not mistaken, I think because of the shift and all that kind of stuff and the reallocation and all that, I think some of his staff have just come over to my staff. It’s hard to say where one leaves and one takes off, and I think that’s the way it ought to be because we’re all sort of in the same boat here, trying to do the same job. I just want to thank you, Senator Specter, for your great leader- ship in the last—well, there’s been so many breaks here—the last (1) 2 4 years, and then before that 10 years on this committee. It was under your leadership that we were able to double the funding for NIH, more than double it, as a matter of fact. It was under your leadership that we accomplished that, and you did it through two different administrations, one Democrat, one Republican. It’s been under your leadership that we have begun to address a lot of the real issues, health issues confronting the American peo- ple, one of which we’re going to discuss here this morning. I would say without any hesitation, if there is one person who has really pushed hard on basic medical research, and here I talk about stem cell research and really taking the lead in that and getting the public informed, Arlen Specter has been on the head of that. So I hope you will all join me in thanking Senator Specter for his great leadership and our continued working relationship on this committee. Thank you, Arlen. Senator SPECTER. Thank you. OPENING STATEMENT OF SENATOR TOM HARKIN Senator HARKIN. I guess, since I’ve got the gavel, the Sub- committee on Labor, Health and Human Services, and Education, and Related Agencies, Appropriations Subcommittee, will come to order. Again, I want to welcome all of you to this hearing titled ‘‘Pandemic Flu: Progress Made and Challenges Ahead.’’ As you all know, the threat of pandemic flu has not abated. It may have fallen briefly from the headlines, but the problem re- mains. Bird populations across Asia have been infected by the H5N1 strain of avian influenza. The virus has spread as far as Eastern Europe. Hundreds of people have died. It may be only a matter of time before this virus mutates and sustained human-to-human transmission occurs. If this virus is able to do this, achieve this, which has been the history of viruses, millions of people may die worldwide, rivaling the Spanish Influ- enza outbreak of 1918 and 1919. The CDC has estimated that a medium level pandemic could kill over 200,000 Americans and sick- en a third of our population. Now just a little history here. The President’s original request to combat the pandemic threat was $7.1 billion in 2005. To date, this committee, again under Senator Specter, appropriated $6.1 billion for pandemic flu preparedness, including $600 million for State and local preparedness. This money has gone to build vaccine capacity, purchase egg-based vaccines, accelerate cell-based vaccine capa- bility, stockpiling antivirals, improving lab capacity at the CDC, and improving surveillance. In addition, Congress has given HHS new authority to develop the tools we need to respond to mass casualty events. Last year we passed and the President signed into law the Pandemic and All Hazards Preparedness Act that was led by my friend Senator Burr, who led that effort in the authorizing committee, the Health Com- mittee, and I was proud to work with him on that. Both Congress and the administration are responding to this threat, but our activities raise new questions. Are we investing in the right vaccine technology? Should we invest in other capabilities beyond cell-and egg-based vaccines? How will this new barter, as it’s called, within HHS change the way we develop vaccines? Are 3 we doing all we can to make sure State and local agencies have the ability to respond? So those are some of the questions that I would pose, and to an- swer