Remarks as prepared; not a transcript.

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

North American Veterinary Conference
Friday, January 17, 2002

Thank you, Dr. (Radford) Davis. Dr. Davis and I attended the University of Arizona at the same time, both pursuing our Masters in Public Health. After that he moved on to ‘greener pastures’ in Iowa.

I stayed in Arizona until March of 2002 when I was very surprised to get a call from the White House. (Expand nomination and confirmation story).

I would like to recognize Dr. Jim Roth, Director of the Center for Food Security and Public Health at Iowa State. Thank you for your work in pulling this conference together.

And I would also like to recognize Dr. Michael Blackwell, Dean of the University of Tennessee School of Veterinary Medicine, and former Chief of Staff in the Office of the United States Surgeon General.

Why We’re Here

The conference you are participating in will have national – even international – implications. To my knowledge this is a unique event to train veterinarians in the recognition of zoonotic agents. I commend your vision and foresight in planning this conference. While this fact is not well known by the public, veterinarians are critical to America’s ability to detect and respond to biological weapons’ threats.

As veterinarians, you are concerned with the health and welfare of animals. And that is a good thing.

Americans are very attached to their pets, and of course many animals have great commercial value to their owners. But from its inception until today, veterinary medicine’s major purpose is still to protect human health, from pathogens often found first in animals.

Of the 1600 pathogens known to infect humans, about one half are zoonotic. That puts veterinarians on the front lines of detection of biological weapons of mass destruction.

While many of us in the field have been working a long time on preparedness issues for weapons of mass destruction, the whole concept of terrorist response and particularly responses to bioterrorism and chemical weapons is very, very new to the American public, and perhaps to many of you here.

The world changed September 11th, 2001. That’s when we learned what our enemies are capable of.

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 they will use to terrorize us are varied, depending on what they can get their hands on. They could use conventional weapons of mass destruction, like explosives, or suicide bombers. They may also have the capability to use biological weapons, such as anthrax, plague, and smallpox; and chemical weapons, such as sarin gas, mustard gas, cyanide and nitrogen, and even, perhaps, nuclear weapons.

As you may have heard, the U.S. government expects that four foreign governments have smallpox in their countries. That alone indicates the potential prevalence of smallpox supply throughout the world, and warns us of the potential threat we all face.

The use of biological weapons is not new and actually dates from antiquity. In 600 BC, Athenian forces at war with other Greek city-states contaminated the rivers with toxic botanical substances.

Fast forward 2,000 years to the 14th century Seige of Caffa near the black sea where Tatar forces catapulted their dead into the city to cause a plague epidemic. Fleeing Genovese forces may have introduced Yersinia Pestis to the rest of Western Europe, thus triggering the Black Death, which killed a third of the population of Western Europe during the ensuing two years.

In 1763, British forces gave Native Americans allied with the French smallpox-contaminated blankets and souvenirs in order to decimate their population which had never been exposed to diseases of the old world.

There are many other examples.

One example which is particularly relevant to the veterinary community is this: During World War I the Germans infected animal shipments being sent to the Allies from five neutral countries, including the United States. The Germans wanted to disrupt our food supplies and transportation networks. They targeted sheep, cattle, horses, and mules. Animals were infected by anthrax – there’s a familiar word! - injected directly into their blood or by being fed sugar laced with anthrax.

This was the beginning of what we are now calling ‘agro-terrorism.’

While terrorism itself is not new, it is a new threat to the American public in terms of its potential to kill millions and destroy the fabric of American society. The challenge – our challenge – is building a public health infrastructure that can identify, mitigate or control any weapons of mass destruction used by our enemies 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.

For those Americans expecting a soft-spoken top doctor, I’m a big surprise.

This image adjustment has been particularly challenging for the uniformed Public Health Service, which I lead as Surgeon General.

Of course, all the officers know about my experience in the Special Forces in Vietnam and as a SWAT team member in Arizona. So on my first day I was having a briefing, when one of the men handed me a folded up piece of paper and said, "We hope you have a sense of humor."

As I opened it, I saw a cartoon of a paratrooper repelling from a helicopter over the ocean with a shark jumping out of the water.

And beneath it the caption read: Admiral Carmona’s new admission’s test for PHS recruits.

I looked up and said to them, "There’s nothing funny about that; it looks like a good test."

Most previous Public Health Service Surgeons General have focused on peacetime health issues such as AIDS, chronic diseases, and teenage smoking. While these things are certainly still important and a major part of my continuing mission, this is not the only mission I must deal with in coming years. My mandate from our Commander in Chief is different.

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

Well before September 11, 2001, the world entered a new era of national security threats – both unconventional and those that target the homeland. Military scholars and historians have warned us for some time that we could expect terrorism to threaten both our civilian population and our armed forces for the foreseeable future.

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 HHS, the Federal Emergency Management Agency, Customs, the USDA 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 1990’s, 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, 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 logistical system on the local level that would allow cities to respond immediately to any terrorist threat, before state and federal assistance arrives.

In the 1990’s 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. 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)

Veterinary medicine has played a key role since 9/11. Following the terrorist attacks, HHS Secretary Thompson pulled together an Emergency Command Center, which operated around the clock responding to the Washington, D.C. and New York disasters, and to the anthrax attack in October. The secretary hired a veterinarian to be part of that command. Also following 9/11, Agriculture Secretary Ann Veneman named Dr. Curt Mann, also a veterinarian, to coordinate that agency’s efforts to protect against future attacks.

Last year the Department of Health and Human Services provided the states with $1.1 billion to strengthen state and local public health infrastructure. That was the largest on-time investment in our nation’s public health system. Ever.

The President signed the bill authorizing this money January 10th. In three weeks HHS developed the grant program and sent 20 percent of the money to states, asking them to develop their plans by April 15. The critics were quick to say it couldn’t be done, that we were asking too much, that states just couldn’t respond that quickly.

The critics were wrong. As we’ve seen time and time again, when challenged, Americans rise to the challenge.

The states sent HHS their plans quickly, and they were solid, well-designed plans. HHS reviewed them and approved them rapidly, and the money is out.

Then in June, the President signed the Public Health Security and Bioterrorism bill, which provides $4.3 billion for bioterrorism preparedness in 2003. That’s a 45% increase over 2002 – the biggest one-time investment in bioterrorism preparedness ever.

Some of that money goes directly to local hospitals, to be used to build surge capacity and patient tracking and to develop and deploy infection control and decontamination equipment.

There is also $1.5 billion to fund state and local preparedness activities, such as improving laboratory capacity, enhancing epidemiological and surveillance capacity, and strengthening communications systems.

There is also direction to the NIH in the 2003 budget to fund $1.8 billion in bioterrorism response to expand basic research, improve laboratory capability, and improve antidotes and vaccinations.

In addition, state and local public health workers and hospitals must have access to adequate supplies of medicines, and must be trained to receive and distribute these essential supplies once they are delivered.

We have enough antibiotics to treat up to 20 million people exposed to anthrax, and have enough smallpox vaccine for every American.

The medical community has also started to look at the veterinary education model, which looks at populations rather than individual patients, so-called ‘herd health management.’

This could be instructive to all of us as we look at ways to respond to weapons of mass destruction.

So we’re doing what we can on the national level to get ready.

But the most important work is being done at the state and local level.

Each state is developing its own plan 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 veterinarians, will be the first to respond. In the case of bio-terrorism, emergency room and hospital personnel will be on the frontlines as the first point of contact for casualties as we saw last fall for anthrax. Local public 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, both in terms of awareness, training and working more closely with public health departments and law enforcement and other homeland security agencies. That’s my piece of it. That’s what I’m going to be relentless about. I will speak to conferences of medical professionals all over the country. I will work with the medical and political leadership throughout the country to develop the public health infrastructure to respond to the unthinkable.

The only way the American people will have faith in us is if we are prepared to meet the threat and communicate that preparedness to the media and the general public. If they see that we are prepared and competent to meet the challenges posed by weapons of mass destruction, the fear – though it will still exist - will be manageable. It will just be fear, not terror.

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 – which will bring the anti-terrorism functions of many government agencies under one cabinet level department.

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

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

As vets, you can play a key role in preparing America. Terrorists might choose to go the way of the Germans in World War I and try to infect animals as a way to disrupt commerce or divert attention from other attacks.

You are here to learn how to recognize the signs and symptoms of the likely disease agents, particularly in the case of those that have not been prevalent in the United States, but which could cause great damage, such as foot and mouth disease, vesicular stomatitis, sheep and goat pox, African horse sickness, and others. I thank you for taking that step – to get educated and help educate others.

It will be important for private practitioners to educate their clients as well. Agricultural producers and even pet owners may be the first Americans to witness an attack of agroterrorism or bioterrorism.

Another step I encourage you to take: join your local Medical Reserve Corps (MRC). This is the health component of President Bush’s volunteer effort known as Freedom Corps, and the one I lead as Surgeon General.

These units, based on the local level, will be made up of volunteers – nurses, doctors, paramedics – who are trained to respond to health crises.

These medical volunteers will be trained to complement and assist full time emergency first responders during large-scale disasters. For instance, these volunteers could be called upon to staff triage and decontamination sites, casualty collection centers, or mass immunization sites.

The Medical Reserve Corps nationally are critical to our efforts on preparedness. They’ll provide assistance and depth to the good emergency teams already in place.

I encourage each of you to become members of your local MRC. Certainly they can use veterinary expertise.

There is a chapter in Rudy Giuliani’s new book, Leadership, titled "Prepare Relentlessly." As Mayor, Giuliani had each city agency map out and rehearse what to do in the face of a chemical attack or a biomedical attack, a plane crash or terrorist attack on a large gathering, before 9/11. While they had not anticipated having planes turned into guided missiles, the preparation is what enabled the police, fire department, even the sanitation department, to perform so heroically and effectively. It was that competence and preparedness that both enabled the city to respond to the attack, save thousands of lives, and to calm people after the attack on the World Trade Centers and subsequent anthrax crisis.

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

We are counting on you. During the tragic events of September 11th and the weeks that followed, we saw ordinary 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 fire officers. The newest designer logo read FDNY.

In case of an attack, you will join police, paramedics, doctors 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.

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Last revised: January 9, 2007