Release of foot-and-mouth disease from Pribright (UK-HSE 2007).
The final integrative step of a risk assessment is a risk characterization, which is a summative description of the consequences in a form that is most useful to stakeholders and decision makers (NRC 1983, 1994, 2009). For the SSRA, the metrics to be used for risk characterization have not been clearly delineated. There are multiple possible adverse consequences from a potential release of agents and agent countermeasures, including illnesses (morbidity), death (mortality), direct economic consequences, and indirect economic consequences
Even if only human-health consequences were to be used as the metric of characterization, it is not clear whether the end point of interest (to the decision makers and stakeholders) is mortality; morbidity (perhaps divided into mild, moderate, and severe cases); or perhaps an integrative measure, such as disability adjusted life years (Murray and Lopez 1994). The metrics for risk characterization should be explicitly delineated in the SSRA (see Box 1, EPA 2004). The committee cannot offer specific recommendations for the most appropriate risk-characterization metrics because it will depend on the decision criteria and the objectives and preferences of the decision makers and stakeholders.
It is important to engage stakeholders throughout the risk assessment process to the extent feasible (PCCRARM 1997; NRC 2009). At the March 21, 2011, public meeting, thoughtful, constructive comments were provided by the community. At the meeting and in the past, the community members have repeatedly requested that risk evaluations for laboratory facilities at Fort Detrick include a comparative risk assessment with alternative locations, such as remote or sparsely populated areas. The NRC committee that evaluated the Army’s USAMRIID facility at Fort Detrick was supportive of conducting such an exercise because it would help “[distinguish between] risks and factors that are dependent on siting location (for example, the potential for disease transmission to livestock and wildlife in rural settings that could result in zoonotic outbreaks, or the availability of medical and emergency personnel) and those that are independent of site (for example, risks of a malicious insider)” (2010a, p. 53). Such an analysis should be considered for the MCMT&E facility as a means of addressing the concerns of community stakeholders.
The committee is pleased that the Army will involve the Fort Detrick Containment Laboratory Community Advisory Committee in its plans for the MCT&E facility. The Army is urged to present any significant changes in the proposed operation of the facility, such as the introduction of additional pathogens, to the advisory committee. This procedure could be implemented through the establishment of formal, regular communications between the advisory committee and the MCMT&E facility’s Institutional Biosafety Committee.
Another concern of the Frederick community is the ability of the health-care system to respond to a major outbreak. To address such concerns, a thorough analysis that assesses the impact of a localized outbreak on the health-care sector should be performed, including the impact of public reaction (e.g., the “worried well”) on available resources. Highly stressed hospitals (e.g., high occupancy levels and understaffing) can pose a risk to quickly mitigating the spread of a disease. A finding from a previous NRC (2010a) committee that reviewed the USAMRIID laboratory at Fort Detrick was “the lack of readily available clinicians with the necessary specialized training to consult on the clinical diagnosis and treatment of unusual infectious diseases.” The report made recommendations for possibly filling this gap that would be relevant to the MCMT&E facility.