Remarks as prepared; not a transcript

Vice Admiral Richard H. Carmona, M.D., M.P.H, FACS
Acting Assistant Secretary for Health
United States Surgeon General
U.S. Department of Health and Human Services

American Pharmaceutical Association (APhA) Conference - Academy of Students of Pharmacy (ASP) Opening Session

New Orleans, Louisiana
Saturday, March 29, 2003

"Preparedness and Pharmacy Science"

Thank you, Patrick, for that kind introduction. [Patrick Brady, National President of AphA-Academy of Students of Pharmacy, PharmD Candidate, University of Kansas]

I would also like to recognize the United States Public Health Service pharmacists here today, including my friends RADM Richard Walling and RADM John Babb. Thank you all for your leadership.

It is great to be here with you. The best part of my job is speaking with students.

While I would normally speak to your group about specific issues in pharmaceutical training, research, and management, the issue of terrorism preparedness is a priority right now, and that’s what I will focus on today.

I commend the American Pharmaceutical Association’s Academy of Students of Pharmacy for all you’ve done to offer educational opportunities in emergency preparedness.

Many of you here today participated in one of the eight sessions that ASP offered throughout the nation last fall to increase the dialogue about how pharmacists can and should prepare for possible catastrophic events.

I’m also glad that my friend Ted Tong and his student Shelly McDiff, from the University of Arizona, will lead an ASP workshop this afternoon on bioterrorism preparedness.

This type of foresight and leadership shown by ASP is essential to our ability to meet the threats posed by weapons of mass destruction.

And, while this fact is not well known by the public, pharmacists can play a critical role in America’s response to the new threats we face.

War and Terrorism

The terrorist attacks of 9/11 brought home to us the realities of a new type of warfare. That threat continues as we are at war with Iraq.

Each of us must strengthen our resolve, as individuals and as part of a larger community, to meet the new challenges with courage.

While we do not know what the future holds, we can look ahead with confidence.

We have the greatest fighting forces in the world, we are prepared for emergencies here at home, and we stand on the shoulders of our great countrymen and women who have fought and made the ultimate sacrifice for us in past conflicts.

This is again a time of testing for America. And I have no doubt we will succeed.

Terrorists want to destroy our lives. Perhaps more important, they want to inspire such fear and panic that we lose the things that are most important to us: individual freedom, economic prosperity, and personal security.

The means and methods that they will use to try to terrorize us are varied — depending on what they can get their hands on.

As a nation, we are better prepared than ever to meet the threat of terrorist attack, but the possibility of the intentional use of biological or other dangerous pathogens represents a threat to our society.

The challenge — our challenge — is to build upon our existing public health infrastructure in order to effectively identify, prevent, mitigate, or control any weapons of mass destruction used to attack the homeland.

This won’t be easy. But it is possible. And we’re going to do it.

Role of Surgeon General in Preparedness

Today we live a world where the nation’s health and the nation’s defense are more closely intertwined than ever. Never before in history has there been this intersection between public health and public preparedness.

The new threat we face — weapons of mass destruction causing immediate large numbers of civilian casualties — means we now need to combine the disciplines of medicine and law enforcement and the military.

Prior to me, most U.S. Surgeons General have focused on peacetime health issues such as AIDS, chronic diseases, and teenage smoking. While these things are certainly still worthy of our focus and a major part of my continuing mission, they are not the only mission I must deal with in coming years.

My mandate from our Commander in Chief and Secretary Thompson is different.

I will focus on ongoing peacetime issues, such as disease prevention and health promotion, and I must also key on wartime medical preparedness, including homeland security and the war on terrorism.

I’d like to spend a few minutes laying out where we are on preparedness issues, and where we’re headed, and how you fit in.

Preparedness Past, Present, and Future

Preparedness Past – Before 9/11

While 9/11 was the event that brought anti-terrorism efforts to the fore in the minds of the public, many of us have been working to get ready for just this type of threat for years, not just months.

In fact, you might say that the work of agencies like Health and Human Services, the Federal Emergency Management Agency, Customs, the Department of Agriculture and others on other disasters and emergencies over the years has laid the groundwork for what we are doing now to fight biological and chemical threats.

During the 1990s, following the news that Iraq and the former Soviet Union were developing biological weapons, and after numerous attacks such as the 1993 World Trade Center bomb, the sarin chemical weapon attack in the Tokyo subway, and the 1998 terrorist bombings of our embassies, the U.S. Congress began funding preparedness efforts in earnest.

In preparation for the 1996 Olympics, Metropolitan Medical Strike Teams were formed in Washington, D.C. and Atlanta. Replication of this program in other cities proceeded rapidly.

Following passage of the Nunn / Lugar / Domenici legislation, 120 cities were funded under the name of the Metropolitan Medical Response System.

The goal was to plan and put in place a coordinating system on the local level that would allow cities to respond immediately to any terrorist threat, even before state and federal assistance arrived.

In the 1990s the Centers for Disease Control and Prevention began to enhance the nation’s epidemiological and laboratory systems.

That’s when we began looking at what the threat might look like, whether a biological threat like smallpox, anthrax, or plague, or something that could be distributed through the food or water system, such as salmonella or cryptosporidium, or even a chemical agent like sarin or mustard gas.

The CDC developed the Critical Agents List so that we could plan a system of response to those threats.

That’s when we began stockpiling pharmaceuticals, antidotes, and emergency equipment in case of mass exposure to a biological or chemical weapon.

This preliminary work already being done created a broad framework for the federal government to put programs and money in place to fight chemical and biological threats in the post 9/11 world.

Preparedness — Present (since 9/11)

Pharmacists have played a key role since 9/11. For example, civilian pharmacists serving with the National Disaster Medical System, and U.S. Public Health Service Commissioned Corps pharmacists responded in New York City; at the Pentagon; and in rural Pennsylvania.

They provided care and leadership. Your profession was well represented at these emergency sites.

And pharmacists have been key players in helping to develop the Medical Reserve Corps, which I lead as Surgeon General and will discuss in greater detail shortly.

Your involvement in our preparedness efforts is important because of the special skills your profession brings to the table. All of you can play a role in supporting the larger efforts underway, at the federal, state, and local levels.

HHS Investments in Preparedness

And there are resources in place to ensure that your profession is a part of the efforts. Let me start with what the Department of Health and Human Services, under the leadership of Secretary Thompson, has done since 9/11.

In the 18 months since 9/11, HHS has spent or requested $9.2 billion to prepare America for a bioterror attack.

Here is how some of that money is being invested:

  1. Project BioShield: A 10-year, $6 billion effort to develop effective drugs and vaccines to protect against biological and chemical attack. The Senate Health, Education, Labor and Pensions (HELP) Committee has approved this legislation, and Secretary Thompson testified to the Congress about the need to pass Project BioShield legislation as soon as possible so that the money can start getting into the research pipeline.
  2. Enhancing the National Pharmaceutical Stockpile: HHS has increased the number of Push Packs strategically placed around the country from eight (400 tons) to 12 (600 tons), while increasing the variety of drugs in the stockpile.
  3. State Grants: $2.5 billion in two years. The largest investment in our public health infrastructure — ever.
  4. Smallpox and anthrax vaccines: We have accelerated development of new, safer smallpox and anthrax vaccines and acquired enough smallpox vaccine for every American, in the event of an emergency.
  5. Commissioned Corps: HHS doubled the number of officers in the Commissioned Corps Readiness Force or CCRF from 600 to 1,200 in one year — increasing the capacity to respond and assist to a public health emergency. I’ll talk more about CCRF in a little while, and I want you to have a pen ready to write down a website address.
  6. Disaster Teams: HHS increased the number of personnel in the National Disaster Medical System by 33 percent, from 6,000 to 8,000 personnel. These include Disaster Medical teams, Disaster Mortuary teams, and Veterinary Medical teams.
  7. We are also using the funds for research on biodefense at the NIH, building new health labs at CDC, and protecting the food supply through the FDA.

We’re doing everything we can on the national level to get ready.

But so much important work is being done at the state and local levels. We need your help.

Many of you will soon join the professional ranks of pharmacists, either in research or practice settings. For those of you who join the private sector, we need you to participate in helping your state to develop and implement plans to detect and respond to a biological attack.

Each state will have different geographical, communications, weather and cultural challenges, all of which must be considered.

America is a huge nation, both in terms of population and physical size. Terrorists could strike anywhere, anytime.

The reality of this is that today, there will be no "special forces" elite unit immediately available from the federal government to contain a biological or chemical attack.

Instead, local EMS, police and fire units, perhaps even you as pharmacists, will be the first to respond.

In the case of bioterrorism, hospital personnel will be on the frontlines as the first point of contact for casualties as we saw last fall for anthrax.

Local health professionals will need to be prepared to determine quickly if the event is a terrorist attack, or another type of threat.

The house of medicine needs to work together, to increase awareness and training and to work more closely with public health departments and law enforcement and other homeland security agencies. We all need to work together.

Preparedness — Future

Our future preparedness efforts will build on the work we’ve done to date.

Last fall, Congress passed an historic bill — the largest reorganization of government in 55 years — brought the anti-terrorism functions of many government agencies under one department.

22 federal agencies with more than 170,000 employees are part of the new Department of Homeland Security.

As Surgeon General, I play a lead role in educating the public about preparedness, and helping build the public health infrastructure to respond to the threats we face.

Two weeks ago I rolled up my sleeve and was vaccinated against smallpox. So was Admiral Babb. We did it to demonstrate to health care professionals who would treat a smallpox infection the importance of being personally prepared ….. of being vaccinated. 

If a smallpox outbreak occurs, we will need our frontline workers to be resistant against the disease to treat the infected patients and to prevent further spread of the disease.

Through vaccination, we remove smallpox from the arsenal of possible weapons terrorists could use against us.

A step you can personally take is joining your local Medical Reserve Corps (MRC).

The MRC is the health component of President Bush’s volunteer effort known as Freedom Corps, and the one I lead. The APhA has been involved from the very beginning, and I thank you and your leadership for that.

These units, based on the local level, will be made up of volunteers — nurses, doctors, paramedics, dentists, pharmacists, and allied health professionals — who are trained to respond to health crises.

These medical volunteers will complement and assist full-time emergency first responders during large-scale disasters.

I encourage you to join your local MRC. This is a great way to apply the pharmacy education you have received and to serve your country.

We need your expertise, and everyone knows that it’s the students and recent graduates who bring the most enthusiasm to any effort.

I also encourage you to consider a career in the Commissioned Corps of the United States Public Health Service. The Commissioned Corps is an elite service with a long, proud history. Here’s that website address I want you to write down for information about the Corps:

Within the Corps, there’s a readiness force with over 150 pharmacists on response rosters who are trained for a wide variety of missions. These Commissioned Corps Readiness Force pharmacists receive intense training on every aspect of the National Pharmaceutical Stockpile.

They are some of the leading experts on appropriate pharmaceutical response to chemical and biological threat agents, and dispensing and distribution options. You should also talk with the uniformed officers who are here at this meeting about the opportunities in the Commissioned Corps.


Throughout the country, in every town and state, we must prepare relentlessly to protect Americans from our new, sometimes invisible enemies.

We must "think outside the box." We may all be called upon to do things we wouldn’t normally do. That’s why we have a United States Senator, Dr. Bill Frist, who has been vaccinated and has also received training in administering the smallpox vaccine.

As pharmacists you have education and expertise most people don’t have; it is quite possible you will be called upon to use it in a new and unfamiliar way in the event of a public health crisis.

Many of you are becoming educated about emergency preparedness, and that’s the first step. I hope I’ve given you some new information today. We are counting on you, as members of a trusted profession, to help communicate the preparedness message to the public.

We need you to be up to speed on emerging threats; their prevention and management. If you are not up to date on anthrax, smallpox, plague, and pandemic flu, you should be. Reliable information is available on the CDC website at That’s the webpage focused on public health emergency response.

I cannot emphasize enough how much we are counting on you to step up.

During the tragic events of September 11th and the weeks that followed, we saw people exhibit extraordinary heroism, just in the performance of their jobs.

Almost overnight, our heroes went from sports stars and Hollywood celebrities to paramedics, police and firefighters. The newest designer logo read FDNY.

In case of another attack, you will join police, paramedics, doctors, nurses, and fire departments as first responders. The American people recognize that their very lives depend upon our ability to do our jobs well. We can’t let them down.

This is an important time in history. Those of us who are charged with the responsibility of protecting our homeland face a daunting — but honorable — challenge. And we will succeed.

Thank you.


Last revised: January 9, 2007