"Failure to Understand Nature of Biothreat"

The evolution of the nature of the threat is nowhere more pronounced than in the area of biological weapons.  A revolution in biotechnology continues, expanding potentially dangerous dual-use capabilities across the globe.  As the delayed response to H1N1 has demonstrated, the United States is woefully behind in its capability to rapidly produce vaccines and therapeutics, essential steps for adequately responding to a biological threat, whether natural or man-made.

H1N1 came with months of warning.  But even with time to prepare, the epidemic peaked before most

Americans had access to vaccine. A bioattack will come with no such warning.  Response is a complex series of links in a chain of resilience necessary to protect the United States from biological attacks. Rapid detection and diagnosis capabilities are the first links, followed by providing actionable information to federal, state, and local leaders and the general public; having adequate supplies of appropriate medical countermeasures; quickly distributing those countermeasures; treating and isolating the sick in medical facilities; protecting the well through vaccines and prophylactic medications; and in certain cases, such as anthrax, environmental cleanup.  We conclude that virtually all links are weak, and require the highest priority of attention from the Administration and Congress. 

The Chair and Vice Chair believe that this lack of preparedness and a consistent lack of action, even on fundamental issues like provision of adequate high-level expertise and investment in medical countermeasures, is a symptom of a failure of the U.S. government to grasp the threat of biological weapons.  

Whereas the Administration has demonstrated a keen understanding of the nuclear threat and has set in motion a series of policies that all hope will bear fruit, there has been no equal sense of urgency displayed towards the threat of a large-scale biological weapons attack. 

The above quote came from page 2 of the Prevention of WMD Proliferation and Terrorism Report Card, produced by the Graham-Talent Commission on the Prevention of Weapons of Mass Destruction, Proliferation and Terrorism this month.

To the credit of the Commission, the report recognized the critical importance of having timely warning and an effective warning-response interface. 

Enhance the nation’s capabilities for rapid response to prevent biological attacks from inflicting mass casualties [Grade: F]  I fully agree with this assessment and would expand upon the example provided in the report of pandemic H1N1 to also include the following events:

• 1957 influenza pandemic
• 1968 influenza pandemic
• 1970 Venezuelan equine encephalitis epizootic in Texas
• HIV/AIDS
• monkeypox
• West Nile virus
• Asian soybean rust (crop disease)
• SARS (months of missed indications of the threat in China)
• vaccine-drifted A/H3N2 in 2007 (warning provided, no virus-matched vaccine available in the US)
• and others

From the perspective of the United States, biological threat events tend to be imported phenomenon.  From an operational perspective, it matters little whether the event was triggered by natural, accidental, or intentional means when similar public health response measures may be required.  Current ambiguity in social recognition of a "problem", lack of an effective National Weather Service-like alerting capability, time delays in engaging and reporting the results of credible laboratory and epidemiological investigations, and hesitation in the warning-response interface represents the deeper broken componentry of the "technical and operational capabilities... links in a chain" referred to by the Commission.

The social behavior of "patting ourselves on the back" with relief after both SARS and pandemic influenza remains troubling.  It reveals a lack of sustained and prioritized social sensitization to the critical nature of this problem.  My concern is a highly disruptive and mortal event on American soil such as the World Trade Center hit to "prove" the validity of the biothreat concern may be the only thing that mobilizes dedicated and prioritized effort.  The classic Cassandra Effect so often seen in the human experience...

Strengthen domestic and global disease surveillance networks [Grade: C].  I completely disagree with this assessment.  The grade here should also be "F".  Current and ongoing problems include:

• Lack of representation by experienced operational biosurveillance professionals on senior advisory panels in biodefense.
• Poor international information sharing, despite revision of the International Health Regulations.
• Continued bias in reporting of human health issues to the detriment of reporting animal health issues with potential impact on human health.
• Failure to support and fund the emerging professional discipline of operational biosurveillance.
• Consistent failure in prioritizing funding towards multi-million dollar information technology platforms and automated approaches without funding the all-important human element: a cadre of experienced professionals who have devoted their careers to this emerging discipline.
• Failure to recognize the significant contributions of operational biosurveillance analysts in biodefense and global biosecurity.

Propose a new action plan for achieving universal adherence to the Biological Weapons Convention [Grade B+].  I agree with this assessment and would refer readers to the National Strategy For Countering Biological Threats, which highlights the need for transparent reporting of disease events to support BWC compliance.

In closing, the assessment lacks recognition of the critical role of operational biosurveillance, a unique and newly emerging professional discipline whose objective is to provide timely warning of biothreats.  Continued overemphasis in funding of technology and automated approaches to the exclusion of the human element in building an effective warning community will result in failure to realize an effective biodefense system for this country.