y first semester as the ASA Lansdale Public Policy Fellow seemed very much like being a student at one of the nation’s largest graduate schools. There are several hundred congressional fellows. Most are individuals with established careers and areas of expertise. All are here to observe and learn about the congressional process in Washington. Some are scientists working through the American Association for the Advancement of Science. Others are educators working through the American Political Science Association. The uniformed services, federal agencies and national laboratories also provide fellowship opportunities for individuals entering senior management positions. Fellows obtain assignments as staff to offices of members or to committees of the House of Representatives or Senate. Many fellows work in areas of their expertise; others prefer to explore new roles. Most conclude that the opportunity to understand how the system works is similar whether or not they work in areas of their personal expertise.

The educational process might be considered participatory case studies. Fellows work with current issues under congressional consideration. The educational resources are electronic media and the excellent documents and research provided through the Library of Congress and the Congressional Research Service. In addition there are frequent seminars in the form of committee hearings and informational briefings. There also is an ongoing curriculum of lectures on procedural and policy issues conducted throughout the year by the Congressional Research Service staff.

Initially I was fortunate to obtain a position on the staff of the House Policy Committee <policy.house.gov/html/about.cfm>. The committee was chaired by Rep. John B. Shadegg (R-AZ). I was assigned the areas of health care, science and veterans affairs. The function of the committee staff is to obtain information for presentation to the members of Congress who serve on the committee. The information that the staff assembles is provided to the members in the form of oral and written briefings. These materials are supplemented by weekly presentations by invited guests.

Areas of health care policy considered by the committee included the Medicare prescription drug program, Medicare physician payment, health care information technology development, avian influenza and policy issues surrounding vaccine and antiviral development. Policy committee speakers included Mark McClellan, M.D., Administrator of the Centers for Medicare & Medicaid Services, David J. Brailer, M.D., Ph.D., National Coordinator for Health Information Technology, and Julie Gerberding, M.D., Director of the Centers for Disease Control and Prevention.

During fall 2005, two events occupied the majority of my efforts, the federal response to Hurricane Katrina and preparation for pandemic influenza. I also had the opportunity to research and prepare a committee publication: “Homeward Bound — Long-Term Care Needs of Returning Veterans” <policy.house.gov/files/homewardbound.pdf>.

During the month of September, documenting the federal response to Katrina and analyzing the policy implications consumed much of the policy committee staff’s efforts. The final report of the Select Bipartisan Committee to Investigate the Preparation for and Response to Hurricane Katrina, “A Failure of Initiative” <www.gpoaccess.gov/congress/index.html> and Frances F. Townsend’s report, “The Federal Response to Hurricane Katrina: Lessons Learned” <www.whitehouse.gov/reports/katrina-lessons-learned>, summarize observations and conclusions reached by the policy committee staff and other larger committees and working groups.

My focus, public health preparedness, began with Hurricane Katrina. Initially I documented events as they occurred during and following the hurricane. Subsequently I had the opportunity to observe congressional analysis of the response through House and Senate oversight hearings. The report by the Congressional Research Service, “2005 Gulf Coast Hurricanes: The Public Health and Medical Response,” summarizes many of the problems that were identified <www.congress.gov/erp/rl/pdf/RL33096.pdf>.

During September I met with Admiral John Eisold, M.D., the attending physician to Congress and former Robert Wood Johnson Health Policy Fellow. Based on his perspective of the emerging threat of an avian influenza pandemic, he suggested that this issue would provide a unique opportunity to study the role of congress in the development of public health policy.

On November 1, 2005, President George W. Bush announced the “National Strategy for Pandemic Influenza Preparedness” and requested an emergency supplemental budget of $6.7 billion <www.whitehouse.gov/homeland/nspi.pdf>.

Prior to the announcement, the Executive Branch had undertaken a thorough assessment of the threat of the H5N1 avian flu virus evolving to a readily transmissible, highly pathogenic strain capable of producing a worldwide human pandemic similar to the influenza pandemic of 1918. The global and national health risks and the risks to global and national security as well as the potential for economic and infrastructure disruption were understood and concurred with by most experts.

In order to provide Congress with an understanding of the analysis that the Executive Branch had completed, and to justify the level of funding requested, a series of congressional briefings and hearings were held. National and international experts in infectious disease and global economics were included in these sessions. Frequently the material was tailored to the specific areas of responsibility of the committee of jurisdiction. Within a period of six weeks, the basic science of the virology, enzootic disease transmission, immunology and pathology was presented along with the national and international plans for surveillance and detection. The current status of international and national public health preparedness and the likely inability to accomplish containment was conveyed. In addition the health, security and economic risks were explained. Because of the scientific complexity of the explanation of the possible evolution from avian to human disease, the current status of vaccine and antiviral development and the multilevel risks associated with a human pandemic, many small group briefings were necessary. These briefings offered the challenge of making scientific concepts understandable to individuals with a limited scientific background.

The hearing process clarified the multilevel complexity of the pandemic threat and risks. Nationally two major areas of concern emerged. One is the lack of adequate supplies of vaccine and antiviral drugs. The second is our current low level of national, regional and local public health preparedness.

Congress carefully evaluated the public health response to Katrina and the proposed plan for the response to a potential pandemic. It debated realignment of the national defense medical system from within the Department of Homeland Security to the Department of Health and Human Services and clarified its role in the national response plan. It also clarified and strengthened the role of the Public Health Service Medical Reserve Corps within the preparedness directorate of the Department of Homeland Security. Congress responded to the president’s request for funding for pandemic preparedness by appropriating an initial installment of $3.8 billion to increase international surveillance and detection, to increase vaccine and antiviral drug development and production and also to fund increased public health preparedness. Legislatively, Congress reduced product liability to encourage the pharmaceutical industry to become more active in vaccine and antiviral drug development and production.

Based on lessons learned from the response to Hurricane Katrina, Congress encouraged and supported efforts to more actively involve states and local governments in public health preparedness planning.
During the first semester of my fellowship, I had the opportunity to observe and participate in the significant role that Congress plays in public health preparedness. The congressional approach to public health preparedness following Hurricane Katrina and in response to the threat of pandemic influenza demonstrated an example of the processes of fact-finding, oversight investigation, policy formulation, regulation and authorization, and funding used by Congress.

William G. Horton, M.D., is Clinical Professor of Anesthesiology, University of Washington, and Emeritus Physician, Virginia Mason Clinic, Seattle, Washington.