Thursday, December 16, 2004

Woefully Unprepared for Bioterror?

The Washington Times reports that despite dramatic increases in funding to prepare for bioterror attacks, the country and most states remain woefully underprepared.

The article claims:

The United States remains woefully unprepared to protect the public against terrorists wielding biological agents despite dramatic increases in biodefense spending by the Bush administration and considerable progress on many fronts, according to government officials and specialists in bioterrorism and public health.

Although administration officials have spoken at times about bioterrorism's dangers, they are more alarmed than they have signaled publicly, U.S. officials said. As President Bill Clinton did, President Bush and Vice President Cheney have thrust themselves into the issue in depth.

"There's no area of homeland security in which the administration has made more progress than bioterrorism, and none where we have further to go," said Richard A. Falkenrath, who until May was Bush's deputy homeland security adviser and is now a fellow at the Brookings Institution.

Unlike many other areas of domestic defense, which are centralized in the Department of Homeland Security, responsibility for biodefense is spread across various agencies. It is coordinated by a little-known White House aide, Kenneth Bernard, whose power is relatively limited.

Biological and nuclear attacks rank as officials' most feared types of terrorist attacks. Because of the technical difficulties in creating such weapons, they reckon the chances of a devastating attack are currently small. But the consequences of a big biological strike could be epically catastrophic, and rapid advances in science are placing the creation of these weapons within the reach of even graduate students, they said.

It is virtually impossible to reach a level of readiness for a major biological strike. Steps can be taken (and have been) to improve first responder and health care providers recognition and training for such a scenario. Community hospitals around the country have been purchasing protective suits, decontamination facilities, and updating plans. For example, my local community hospital has purchased suits, run numerous exercises, briefed doctors and nurses on the challenges of chem-bio terror, updated plans, improved coordination with the state and federal authorities, and considers their progress since 9/11 to be "dramatic."

The great majority of U.S. hospitals and state and local public health agencies would be completely overwhelmed trying to carry out mass vaccinations or distribute antidotes after a large biological attack. Hobbled by budget pressures and day-to-day crises, many health agencies say they cannot comply with federal officials' urgent demands that they gear up for bioterrorism.
How much more prepared can they be? If a major biological strike were to occur in my geographical area, the surge of patients would simply overwhelm the hospital. As was the case with the sarin attacks in Tokyo (see this), the number of people exposed coupled with the large numbers of "worried well" simply dwarfed the available health care infrastructure. No plans can really change this, except to hopefully be able to spread the patients out over a wider medical service area. This could be problematic and time consuming if you are dealing with an infectious disease. It also runs the risk of spreading the disease beyond the immediate area of infection. It is also compounded by the fact that it often takes up to a week for symptoms of a bioterror attack to occur.

On top of this, how many substances should they be prepared for, even if you assume preparation is possible? Anthrax? Ebola? Influenza? Smallpox? Plague? Q Fever? Tularemia? VEE? Typhoid? Brucellosis? How about variants of these agents? How bout modified agent of the type produced in the former Soviet Union? It is literally impossible for all hospitals in the US to be able to deal with this. Already, the CDC has storage facilities and mobile treatment labs strategically placed throughout the country.

Despite considerable progress since the 2001 attacks, the National Institutes of Health, which has the lead role in researching biological warfare vaccines and antidotes, remains largely wedded to its traditional role of doing basic research and is not producing enough new drugs. Large drug firms with track records of developing medications have little interest in making bioterrorism vaccines and treatments.

Due to liability issues, most US pharmaceutical companies are unwilling to produce vaccines of any type. For every vaccine, there will be a small percentage of patients who have an adverse reaction. It is a simple fact of life. It cannot be avoided. This will not improve until vaccine makers are protected from lawsuits resulting from these adverse reactions. If the threat is so severe from the agents, we need vaccines and the ability to create new vaccines for emerging threats. Until we remove the major blocking point for vaccine production, it is not going to be an area that companies will venture into.

All in all, the threat of biological terrorism will likely come in the form of smaller scale attacks, designed to frighten and confuse the government and population. The focus on catastrophic attacks makes sense in a worst cast scenario preparation scenario. However, our ability to reach the optimum level of readiness for a massive bioterror attacks is unlikely no matter how much money we devote to it.

Richard Falkenrath, cited in the article, does an excellent job discussing the threat of covert attack on American in a pre 9/11 work he co-authored entitled America's Achilles Heel. It is a worthwhile read for anyone interested in the subject.