Monday, February 15, 2010

Biological Threats: A Matter Of Balance

Biological Threats: A Matter Of Balance

By Scientists Working Group on Biological and Chemical Weapons

Bulletin of the Atomic Scientists

2 February 2010


Article Highlights


    * Last week, the Graham-Talent WMD Commission

    asserted that a life-altering bioterrorist attack is

    highly likely to take place within the next four

    years. * As such, it called on the U.S. government

    to urgently expand its biodefense measures. * This

    call, however, is misplaced. Instead, Washington

    should put greater focus on improving public health

    capabilities applicable to all infectious disease threats.


The Graham-Talent WMD Commission asserted again last

week that a bioterrorism attack that "will fundamentally

change the character of life for the world's

democracies" is highly likely to occur within the next

four years. The commission argues that the United States

must urgently expand its efforts to develop vaccines and

other medical countermeasures against potential

bioterrorism agents.


We disagree with the commission on both points. It

exaggerates the bioterrorist threat and proposes

solutions that won't produce the comprehensive approach

needed to strengthen public health security.


The bioterrorist threat must be kept in perspective.

Although many fictional "tabletop" scenarios and

exercises have predicted bioterrorism catastrophes,

these scenarios often have used unrealistic values for

critical disease parameters and have routinely ignored

the organizational and technical difficulties that

terrorists would have in organizing, and successfully

carrying out, a bioweapons attack. The history of both

state-operated bioweapons programs and unsuccessful

terrorist attempts to develop and use such weapons

(e.g., the Japanese cult Aum Shinrikyo) have

demonstrated, again and again, the significant

difficulties that confront making and disseminating a

biological weapon. The 2001 anthrax letter attacks,

which were seen as validating the catastrophic

scenarios, appear to have been executed with anthrax

developed in a U.S. biodefense laboratory with

capabilities vastly superior in scale and quality to

anything a terrorist could achieve.


Advances in the life sciences may gradually put

bioweapon capabilities closer within terrorist reach,

but scientific and technological progress alone doesn't

warrant exaggeration of the bioterrorist threat. Rather

than basing policy on worst-case scenarios, the United

States should develop and conduct more plausible,

sophisticated threat assessments that take into account

the complex set of political, social, and technical

factors that would affect bioweapons development and use.


Since the 2001 anthrax attacks, the federal government

has spent nearly $60 billion responding to the perceived

threat of bioterrorism. Roughly one-half of that money

has funded detection systems, dramatically expanded

research on bioweapon agents, and the development,

procurement, and stockpiling of vaccines and other

medical countermeasures against these agents.


As bioterrorism has commanded policy and funding

attention over the last decade, domestic influenza-

related deaths have likely exceed 300,000 people. The

growing problem of multi-drug resistant tuberculosis,

the lack of progress on reducing food-borne infections

and disease outbreaks, and annual U.S. mortality figures

from AIDS (14,000 deaths) and opportunistic infections

such as MRSA (19,000 deaths) all speak to significant

ongoing public health needs. Policy and funding

decisions must be based on more than just mortality

statistics. For instance, government is expected to

respond effectively to acute disease outbreaks.

Nonetheless, these figures underscore that continuing to

emphasize and spend billions of dollars on measures to

specifically counter exaggerated bioterrorist threats

diverts attention and resources from other pressing

natural disease threats and public health concerns.


Moreover, all the money and effort spent on biodefense

hasn't produced demonstrably better overall health

security for the country. Detection systems remain

unreliable triggers for immediate responses. Expansion

of biodefense research has increased the number of

people with access to dangerous pathogens and toxins,

which increases the risk of accidents, infiltration by

outside groups, or attack by a rogue insider. Programs

to develop stockpiles of vaccines against bioweapon

agents continue to face questions relating to efficacy,

safety, shelf life, and timely distribution. Many other

bioweapon-specific countermeasures will be useless

against serious infectious disease problems, other acute

public health threats, or even bioterrorist attacks that

differ from the threat predicted. Despite promises of

broad-based "synergies," most of these efforts haven't

produced benefits for public health, as illustrated by

the problems experienced in the responses to pandemic

influenza A (H1N1).


Nonetheless, the Graham-Talent Commission wants U.S.

policy makers to continue down this questionable path

with more urgency, more money, and more intense focus on

bioterrorist threats. Such an approach will exacerbate

the political and funding gaps between defense against

bioterrorism and protection of the U.S. population from

naturally occurring infectious diseases. Strangely, the

Commission points to the H1N1 pandemic as evidence that

the United States should devote more funding to

biodefense, when the proper conclusion to draw from the

troubles experienced with H1N1 is that Washington isn't

paying enough attention to public health capabilities in

its efforts to strengthen national health security.


Rather than continuing to argue, despite accumulated

evidence to the contrary, that bioterrorism-centric

policy and spending will produce meaningful and

sustainable positive "spillover" effects for public

health, a better, more comprehensive approach to

national health security would focus on improving public

health capabilities to respond to any kind of infectious

disease threat. As the recently released U.S. National

Health Security Strategy states, "Investments should

focus, to the extent possible, on new technologies and

countermeasures that could also have uses in non-public

health emergency situations."


This more comprehensive approach would focus political

attention and fiscal resources on addressing important

public health and national health security needs,



    * Ensuring that the nation's public health system is

    capable of addressing all public health needs,

    including infectious disease outbreaks. Only by

    ensuring adequate staffing and resources in all

    program areas will the United States build a

    sustainable public health system that can strengthen

    individual resistance to disease, improve early

    detection and treatment, and contain disease

    outbreaks, whether natural, deliberate or accidental.


    * Increasing support for the basic tools necessary

    for public health surveillance and epidemiology,

    including skilled personnel, public health

    laboratories, and data collection, management,

    analytic, and information-sharing systems. In this

    respect, the roughly $15 billion in biodefense

    spending to strengthen state and local public health

    capacity and fund other public health efforts has

    been important and needs to be maintained and even enhanced.


    * Enhancing animal disease surveillance and response

    capabilities and their integration with public

    health systems, which would improve the ability to

    rapidly detect and diagnose both animal and zoonotic

    infections and disease outbreaks, whether natural or deliberate.


    * Improving disaster preparedness and response

    capabilities, especially medical surge capacity. The

    capabilities needed to respond quickly and

    effectively to an event that produces a large number

    of casualties are similar whether the event is a

    natural disease outbreak, a bioterrorism event, or a

    natural disaster such as an earthquake or tsunami.


    * Strengthening research on new diagnostics,

    antibiotics, and antivirals for emerging or

    established diseases that cause significant

    mortality or morbidity. An ability to more rapidly

    develop, test, and verify the safety of new vaccines

    after an epidemic or pandemic is also important.

    However, emergency-response strategies shouldn't

    overly focus on vaccination because vaccines usually

    need to be given prior to exposure. New vaccines

    will continue to take time to produce, and

    stockpiled vaccines are highly disease-specific

    (often even strain-specific) and often have a

    limited shelf life.


Public health in the United States faces many

challenges; bioterrorism is just one. Policies need to

be crafted to respond to the full range of infectious

disease threats and critical public health challenges

rather than be disproportionately weighted in favor of

defense against an exaggerated threat of bioterrorism.

Nine years after the anthrax letters, we know better

than to expect narrowly construed biodefense policies to

produce comprehensive health security for the U.S. people.




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