A Unified Strategy for Biodefense Preparedness

It can be difficult to justify investments to protect against risks associated with a biological attack,particularly when compared with: (a) marauding terrorist firearms attacks (e.g., the mall attack twomonths ago in Nairobi, Kenya); (b) IED (improvised explosive device) detonations such as the Bostonmarathon bombing; and (c) even the recent chemical weapons attacks in Syria over the past severalmonths. Each of these headline incidents provided a graphic illustration of the many ways in whichdetermined groups, or even individual terrorists, can plan and then carry out a successful attackagainst a predetermined target. In contrast, instances of bioterrorism are not only less frequent but also less tangible – for example, the April 2013 mailing of ricin-laced letters in Washington, D.C., and the much earlier anthrax mailings shortly after the 9/11 terrorist attacks. Moreover, bioterrorism attacks do not cause the visible destruction found with any of the other types of attacks described above, so it is very easy to underestimate the danger such attacks really pose. Finally, many people often loosely categorize biological attacks with naturally occurring biological incidents – epidemics and pandemics, primarily – which at some level diminishes the gravity of the situation. Because many U.S. residents consider naturally occurring disease outbreaks to be an inevitable part of life in nations far distant from the United States, they tend to draw conclusions, under false pretenses, about the potentially catastrophic dangers posed by bioterrorism incidents.

Biological vs. Other Attacks

There are several reasons why concern for a biological incident should receive no less attention than any other threat and, some analysts would argue, should probably receive more attention. The risk posed by an attack with a biological weapon almost anywhere in the United States is, by any measure, a clear and present danger against the entire nation. Past and recent epidemics and pandemics are illustrative examples of how such an attack might unfold based on three principal reasons. First, a successful biological attack would take a horrendous toll on the American society as a whole. The worldwide burden of infectious diseases, in terms of lives lost – hundreds of thousands of people die each year from exposure to infectious diseases worldwide – is already painfully real. According to its website, the World Health Organization (WHO) conservatively estimates that, worldwide, Japanese encephalitis kills about 10,000-15,000/year (posted in November 2011), yellow fever about 30,000/year (posted in May 2013), malaria about 600,000 in 2010, and tuberculosis about one million in 2012 alone. In the United States, the ninth leading cause of death among adults is influenza and pneumonia, which the U.S. Centers for Disease Control and Prevention (CDC) estimated reached more than 50,000 in 2011. The release of an engineered biological weapon has the potential to match these mortality rates in a much shorter time, particularly when compared to a pandemic that might drag out for several months or more. Second, the long-term impact of a biological attack is usually not confined by national borders. Although the perceived threat of emerging infectious diseases is often far removed from domestic shores, today’s ability to travel from anywhere in the world to anywhere else in the world, no matter how distant, in less than 24 hours makes every corner of the earth vulnerable to the spread of biological diseases. History shows that most terrorist attacks are in fact geographically limited – primarily because, when they use conventional weapons, the attackers often have only one opportunity to violently disrupt society and destroy lives. However, a biological attack does not have to occur within U.S. borders. In fact, the strategic and invisible deployment of a small number of suicide fighters armed (or infected) with a biological agent could cause a hundred fold more deaths, compared to the much lower toll killed by a suicide bomber. The emergence ten years ago of the Severe Acute Respiratory Syndrome (SARS) virus may be an unintended example of future bioterrorist attacks. In 2003, a mere handful of people, who unbeknownst to themselves were carrying the SARS virus, travelled from Hong Kong to other destinations throughout the world. Ultimately, their journeys resulted in the death of 774 people from complications caused by that virus. Third, advances in technology have facilitated the ability to “custom-engineer” biological agents. Although biological weapons have not been successfully employed to the maximum extent for which they probably were intended (e.g., the failed Aum Shinrikyo anthrax attacks which had the capacity to cause great devastation, but did not), today’s technological advances make the development of biological weapons not only very accessible but also easier to spread. In the past, some nation states invested heavily in biological weapons programs by creating their own clandestine laboratories. Today, numerous countries invest in national biotechnology programs as an economic driving force, and Do-It-Yourself biohackers are trending to compete with the nationally funded institutional laboratories. In short, the resources needed are readily available and the technological knowledge to encourage malicious intent already exists.

Biological Attacks vs. Pandemics

Convincing officials that it makes sense to invest in the countermeasures needed to respond to a biological incident may succeed, unfortunately, only after experiencing yet another pandemic or an actual biological attack. With naturally occurring epidemics and pandemics illustrating the outcome of a biological attack, any efforts to mitigate such public health threats also can help to develop and implement effective countermeasures against the use of biological weapons. The first step, though, should be to continue developing new and better vaccines against biological pathogens. Such vaccines are perhaps the most powerful tools already in the public health arsenal because they can be effective in reducing the combined burden of morbidity and mortality. Their principal drawback is that vaccines are very expensive and cumbersome to develop, sometimes with little financial return on investment for the pharmaceutical companies involved. Despite the major strides forward in building a bigger and more varied arsenal of vaccines, there is still much more to do. First, public health agencies require more vaccines against diseases that have a high morbidity rate; many of those vaccines would provide helpful directions on how a biological weapon might burden the medical health system. Second, a number of vaccines require various improvements to increase their short- and long-term effectiveness; some existing vaccines are not as effective as they should be in providing protection against biological agents. Third, the time and effort needed to develop and produce vaccines is often a lengthy process; with few dedicated facilities available to produce massive quantities of vaccine, on short or no notice, to cope with a deadly pandemic or biological attack, considerable time might pass before it is possible to mount a truly effective response.

Reasons to Care

Pushing for technological advances and expanding the arsenal of vaccines available against emerging infectious diseases can help increase the level of readiness (i.e., response rate and versatility) for responding to a biological incident, regardless of whether the outbreak is caused by a pandemic or a biological attack. Creating and expanding the knowledge base, the technology, and the investments needed all contribute to reducing the rigidity associated with a push for new vaccines that are more accessible and delivered quickly. In fact, the only real certainty than can be postulated is that the next biological threat will be unexpected and unanticipated; therefore, the United States and its partner nations throughout the world are already at a disadvantage. Without an effective infrastructure – including rapid vaccine development and production facilities – in place to respond quickly, the initial response will probably not be very effective. To achieve a more rapid as well as more effective capability, the first step must be to build an infrastructure capable of producing larger and more effective quantities of vaccines. The encouragement and funding of public-private partnerships can help facilitate such infrastructure – and reap the subsequent benefits. This has been a watershed year for private-public partnerships, which have stepped up to begin building the next generation of vaccines to eradicate the public health burden imposed by many deadly diseases. One notable example is that U.S. nonprofit organizations are now working alongside private industry to develop the newest and most promising vaccine against malaria. The most obvious benefits derived from these partnerships are that: (a) investments are helping to advance vaccine design technologies; and (b) production processes are not only increasing the versatility of vaccine development but also doing so at lower costs. The most important results, though, will be a reduction in the high morbidity rate of many infectious diseases worldwide. Providing a solid foundation of political as well as financial support for such efforts will help all nations prepare more effectively for a biological attack – when, not if, it occurs.
Patrick P. Rose

Patrick P. Rose, director for pandemic and catastrophic preparedness at the National Association of County and City Health Officials, holds a Ph.D. in infectious diseases and is a subject matter expert on national security issues related to public health security. He works with federal and local stakeholders to address requirements and gaps that produce vulnerabilities in public health security. In addition, he supports efforts domestically and internationally in the field and at the policy level to reduce the proliferation of biological weapons and to increase public health security awareness. These efforts include promoting greater engagement in the Global Health Security Agenda. He is an alumnus of the Emerging Leaders in Biosecurity Initiative and serves as an adjunct assistant professor at the University of Maryland Department of Epidemiology and Public Health.



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