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Cracks in the System—An Examination of One Tuberculosis Patient’S International Public Health Threat

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Cracks in the System—An Examination of One Tuberculosis Patient’S International Public Health Threat S. HRG. 110–359 CRACKS IN THE SYSTEM—AN EXAMINATION OF ONE TUBERCULOSIS PATIENT’S INTERNATIONAL PUBLIC HEALTH THREAT HEARING BEFORE A SUBCOMMITTEE OF THE COMMITTEE ON APPROPRIATIONS UNITED STATES SENATE ONE HUNDRED TENTH CONGRESS FIRST SESSION SPECIAL HEARING JUNE 6, 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 41–837 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 Tom Harkin .......................................................... 1 Opening statement of Senator Arlen Specter ........................................................ 3 Statement of Julie Gerberding, M.D., M.P.H., Director, Centers for Disease Control and Prevention, Department of Health and Human Services ............ 4 Prepared statement .......................................................................................... 11 Statement of Deborah J. Spero, Deputy Commissioner, United States Cus- toms and Border Protection, Department of Homeland Security .................... 17 Prepared statement .......................................................................................... 19 Statement of Anthony S. Fauci, M.D., Director, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Department of Health and Human Services ............................................................................... 22 Statement of Senator Sherrod Brown .................................................................... 35 Statement of Andrew Speaker, Speaker Law Firm, Atlanta, Georgia ................ 42 Statement of Steven Katkowsky, M.D., director, Department of Health and Wellness, Fulton County, Georgia ...................................................................... 45 Statement of Nils Daulaire, M.D., M.P.H., president and chief executive offi- cer, Global Health Council .................................................................................. 48 Prepared statement .......................................................................................... 50 (III) CRACKS IN THE SYSTEM—AN EXAMINATION OF ONE TUBERCULOSIS PATIENT’S INTER- NATIONAL PUBLIC HEALTH THREAT WEDNESDAY, JUNE 6, 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 9:48 a.m., in room SD–192, Dirksen Senate Office Building, Hon. Tom Harkin (chairman) presiding. Present: Senators Harkin, Specter, Cochran, and Gregg. Also present: Senator Brown. OPENING STATEMENT OF SENATOR TOM HARKIN Senator HARKIN. Before we proceed, we’re trying to get a witness who could not be here, to be here, at least telephonically. We had hoped to have it visually also, but there seems to be some problems at National Jewish Hospital hooking us up. But we’re going to have Mr. Speaker, I hope, telephonically here momentarily. I just want to make sure that we have him so that he can hear the proceedings as we proceed, because Mr. Speaker will be on our second panel. Hello; is this Mr. Speaker? This is Senator Harkin in Wash- ington. Can you hear us? Mr. SPEAKER [by telephone]. Say it again? Senator HARKIN. Mr. Speaker, this is Senator Harkin, chairman of the subcommittee. We are just—I just called the meeting to order. I just want to make sure that you could hear the pro- ceedings. Are you hearing the proceedings now? Can you hear me? Mr. SPEAKER. Yes. What is this meeting for? Senator HARKIN. What did he say? Mr. SPEAKER. What is this meeting for? Senator HARKIN. I’m sorry. This is the Subcommittee on Labor- HHS that has jurisdiction over NIH and the Centers for Disease Control. This hearing is to basically look into the circumstances surrounding the events of the last few weeks concerning your case and what needs to be done to ensure that things like this don’t happen in the future. That’s the subject of this hearing. We had hoped to have you hooked up visually, but there seem to be some problems in Colorado with that. But we have you tele- phonically. So I just ask you to listen to the proceedings, and then we have one panel. I will lay that out for you. You’ll hear that. Then you’ll be our witness on the second panel. (1) 2 Do you understand that? [No response.] Well, while they’re trying to get the bugs worked out of this: I’m sure everyone has heard now about the case of Andrew Speaker, the person who we just heard briefly on the phone, who was diag- nosed with an active drug-resistant form of tuberculosis. On May 10, Mr. Speaker flew from Atlanta on a 12-day international odys- sey, which he continued despite warnings from the Centers for Dis- ease Control and Prevention. Then he reentered the United States at the Canadian border when a Customs agent allowed him to pass, despite knowing that Mr. Speaker was being sought by health authorities. During this hearing we’ll hear testimony from Mr. Speaker by live hookup. At least I hope we will. Obviously, this case raises grave questions on how prepared we are as a Nation to prevent the spread of a dangerous infectious dis- ease. This subcommittee, under the leadership of Senator Specter and myself, has made it one of its top priorities, if not the top pri- ority, to make sure that our public health infrastructure is ade- quately funded to respond to natural or man-made biological threats. We have provided funds for disease surveillance here and abroad. We have invested in the Centers for Disease Control and Prevention and our State and local public health systems. We have funded research in vaccine development. We have Dr. Fauci here to speak about that. We have held hearings on bioterrorism and on pandemic flu, numerous hearings, under the leadership of Senator Specter. We did this because we know that public health, both on the Federal and local levels, is our first line of defense against new and existing infectious diseases. We did this because we knew the threats we face from both bioterrorism and emerging infectious dis- eases, for example SARS or pandemic flu. In the case of pandemic flu, we know that we have to count on public health because with an outbreak we will have to wait perhaps months before we have an adequate vaccine after an outbreak. That’s why I’m dismayed and concerned that so many things went wrong in this case of a drug-resistant tuberculosis. This is not the first and will not be the last time that we count on our public health system to keep us safe. Some things went right. The doctor who first diagnosed the TB in the Atlanta man did indeed report the case to the local health department. The local health department did respond and either suggested or directed—I don’t know which—that the patient not travel overseas. But then the records kind of get confused and a little less clear. Clearly there are some gaps in planning on how to control the trav- el of persons with dangerous infectious diseases. It’s as though the issue had not been raised before. We’ll get into that with Dr. Gerberding. We’re told that there were legal issues to resolve. Well, we need to know what those are, but it seems to me that sound planning calls for resolving those issues in advance. That’s where I really want to kind of guide and direct this hearing as to what happened in the planning to take care of a case like this. 3 The purpose of this hearing again is to learn more about what happened and, more importantly, to learn what’s being done to pre- vent something like this from happening again. Bear in mind that an incident like this could have happened on a cruise ship, a train, commuter subways, wherever. We need to be planning for these kinds of possibilities and we need to test those plans, to test them to see if they’ll work in the real world. So this hearing will give us an opportunity to learn more about also the growing problem of drug-resistant tuberculosis and other drug-resistant infectious diseases, what’s being done and should be done to address those threats. That’s where we’ll get with Dr. Fauci on those. With that, I’d yield to my colleague and again person who has led this committee for so many years in making sure that we had funding for CDC that we have funding for NIH, to make sure that we’re able to address these issues if and when they arise.
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