Potomac Perspective: Bioterrorism Preparedness

February 4, 2005

News Release

Arlington, VA – With the recent nomination of a new Secretary of Health and Human Services, as well as a new Secretary of Homeland Security, the topic of bioterrorist attacks has come to the forefront of concern among Americans. Dr. Stephen Prior, Director of the Potomac Institute’s National Security Health Policy Center, gives us his outlook on the current state of the United States’ bioterrorist preparedness and what direction he sees terrorism moving.

Q: What do you think are the emerging biological threats facing the United States?

A: “While the news continues to report terrorist threats posed to the United States, the next real threat may well be a creation by Mother Nature. “ As we review the current concerns about the possibility of disease outbreaks, the greatest threat to the United States is a pandemic influenza. With even a moderate lethality rate of around 1 in 10,000 of those persons infected, 89,000-207,000 Americans could die from this disease.

“Not to be confused with seasonal influenza, a pandemic influenza usually begins with an initial spread from animals to humans. The first human cases are initiated when avian influenza (‘bird flu’) is transmitted to humans through consumption of incompletely cooked, or raw, meat or blood. Once it has come into contact with humans, the influenza virus, under the pressures of natural selection, mutates and ultimately ‘acquires’ the ability to be transmitted from one human host to another uninfected individual. The ‘outbreak’ has begun. Further human-to-human transmission of the highly infectious flu virus creates a focus for the new influenza.

“In the case of a pandemic episode, (the world saw three such episodes in the 20 th Century – 1918, 1957, 1968) the highly contagious disease rapidly spreads around the globe, carried by our increasingly mobile population of national and international travelers. In the past few months, scientists have once again reported transmission of an avian flu (this one is called H5N1) to humans. Last week, the New England Journal Of Medicine published a special release describing the investigation of how this virus was probably transmitted from person-to-person.”

Q: Is a pandemic influenza inevitable?

A: ““The answer is a cautious ‘not yet.’ The circumstances surrounding these initial reports suggest that the virus has not yet ‘acquired’ the ability to ‘jump’ freely between humans. However, its presence in humans is troublesome and will increase the chances that a new ‘pandemic influenza’ is not too far away. The Institute of Medicine is noting that, ‘Most infectious disease experts believe that the world stands on the verge of an influenza pandemic’. This influenza virus is not a weapon that can or would be readily used by terrorists. Only Mother Nature can create and spread this disease. Of course, in some ways she can be the worst terrorist of all.

“The NSHPC is already working hard to develop the policies that are being created to better prepare the nation for a pandemic influenza. We are currently working with the Center for Disease Control in Atlanta, GA to help write the CDC’s Pandemic Influenza Response Plan. A revised version of the plan will be released at the end of the month.”

Q: With the biggest biological threat facing the United States being a threat from Mother Nature, and with all of the upgrades security, emergency planning, and intelligence, do bioterrorists stand a chance to attack the United States?

A: “Terrorists aren’t static. They are reading our newspapers and reports of government and non-government agencies, and watching what we do. They will adjust their plans accordingly. We have to recognize that the ‘enemy’ is a living entity that will adapt and develop its plans to respond to our efforts. They will seek out our vulnerabilities and possibly target those in future efforts.

“Now, , a greater number of people have the tools and abilities to handle bioterrorist materials. The technologies that we had in development National Laboratories in the 1970s are now used in high schools. It has become easier for bioterrorists to handle and manipulate biological materials to create, for example, anti-microbial resistant microorganisms, which could harm the public and present significant problems for a response that relies on provision of antibiotics. The use of a contagious microorganism, that is transmitted human to human, disrupts the working and social life of Americans, paralyzing society. An attack of this sort would cause our networks to breakdown and cause economic instability, which we understand is one of the principal goals of terrorists.

“The NSHPC has completed a significant amount of work on response to bioterrorist incidents. Last year, the Center, along with other groups, organized an exercise called “Missouri Blues” that simulated a bioterrorist attack in the ‘Show me State’. The exercise brought together local, state, and federal groups to respond to an outbreak of ricin poisonings. Integration across agencies is essential when it comes time to respond to emergencies like those simulated. This integration becomes problematic when all of the agencies are stove piped, causing fragmented consequence management and uncoordinated responses.”

Q: Along with interagency coordination, what problems did you notice with the emergency simulation?

A: “Overall, interagency coordination proves to be the most important aspect during an emergency. Although the new Secretaries of Homeland Security and Health and Human Services may work together, the greater parts of the departments can still have a difficult time working with one another. Integration among Departments continues to pose an issue as budgets get tighter with the current war. As budgets become smaller, fewer people are willing to share their money with other Departments, even if it could result in an effective interagency relationship.

“There were two major missing components to the plan that was used to conduct the Missouri Blues Exercise. The first was that it didn’t involve as much engagement of the private sector as we would have hoped. Over 85% of the resources needed during times of emergency lie in the hands of private industry. The second issue was the assumption of what the public would do. Although you can try to predict what the public will do, you don’t really know. Through surveys we know what television program they will watch, and what kind of candy bar they will eat, but no one has thought to ask large numbers of them what they would do in an emergency. Emergency simulations are only as good as the people who are involved.

“NSHPC is currently working with Quantum Leap Innovations in Newark, DE to develop intelligent software for the Office of Naval Research and for the Homeland Security Advanced Research Projects Agency in a recently announced initiative. This intelligent software will develop a flexible mechanism to detect and respond to biological or chemical attacks in collaboration with local, state, and federal emergency response officials. This software will enable dynamic planning among all emergency responders, creating an efficient and effective reaction to the attack.”

Q: With the increase in money going to study bioterrorist issues, where do you think the United States should be investing money?

A: “Understanding the relationship between pathogens and humans is one of the most sound investments we might make in the next few years. New technologies that enable us to understand the function of the DNA in the human genome, how the proteins, derived from the DNA, work and interrelate in the day-to-day functions of life are just a few steps away from allowing us to understand how pathogens cause disease in humans. Understanding the pathogen:host relationship could help us engineer mechanisms to improve humans’ response to disease once infected with a pathogen. Once we better understand the interaction between the host and pathogen, we can influence the outcome of that interaction to tip in favor for humans over pathogens.

“The NSHPC is currently working with George Mason University – Krasnow Institute to build a system that models and simulates anthrax infections in humans. The In silico Anthrax Modeling simulates how a pathogen interacts with a host and how the host responds to the pathogen. This anthrax modeling is paving the path to analyze other pathogens in the future. Modeling and simulation of pathogens will help further our abilities to make sound investments in pathogen research.”

Q: What do you see in store for the NSHPC?

A: “In the game of life the interaction between hosts and pathogens is a constant theme. With a host of human diseases to study, with Mother Nature continually ‘experimenting,’ and the bad guys ‘exploring’ whether bioterrorism is a viable option, there are plenty of options for future research. Those studies may or may not include in the near future a modeling component like the one for anthrax I described, however, they will undoubtedly result in new technology options. If all goes well, the NSHPC will be there to comment on the technology and help to craft some of the policies that will enable us to leverage the technical solutions for the advantage of us all.”