Biological Threats and Terrorism Assessing the Science and Response Capabilities: Workshop Summary (2002) / Chapter Skim
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6 Scientific and Policy Tools for Countering Bioterrorism
6 Scientific and Policy Tools for Countering Bioterrorism
Pages 182-219
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From page 182... ...
These ideas include multiple components of the individual sessions and have cross-cutting implications for an overall response to biological threats. Surveillance Surveillance and rapid detection are crucial to an effective response to a bioterrorist attack.
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From page 183... ...
The capability to use molecular sequences to rapidly detect and identify bioterrorist agents could serve as an important form of deterrence and might possibly prevent bioterrorist attacks from occurring in the first place. One vision is an international molecular forensics lab that would rely on a molecular fingerprint global database to identify the source of the bioterrorist agent.
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From page 184... ...
. There is concern about who should have access to certain scientific materials, equipment, and information and whether access to select agents should be restricted.
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From page 185... ...
Plans to improve ~ Department of Defense Global Emerging Infections System, Silver Spring, MD 2 New York City Department of Health, New York, NY (current aff~liation OutbreakDetect, Inc., New York, NY) 3 US Army Medical Research Institute of Infectious Diseases, Fort Detrick, MD 4 Human Health Services Division, Food Safety and Inspection Service, Washington, DC 5 Johns Hopkins University Applied Physics Laboratory, Laurel, MD 6 New York City Department of Environmental Protection, Valhalla, NY 7 Naval Health Research Center, San Diego, CA ~ Air Force Institute for Environment, Safety and Occupational Health Risk Analysis, Brooks Air Force Base, TX 9 George Mason University, Fairfax, VA ~° Prince William County Health District, Manassas, VA Clinical Toxicology and Poison Control, Children's Hospital of Philadelphia, Philadelpia, PA
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From page 186... ...
New York City 911 Calls Beginning in March 1998, the New York City Department of Health, in collaboration with the Mayor's Office of Emergency Management and the Fire Department's Emergency Medical Services, began monitoring the chief clinical complaints noted in daily 91 1 calls as a citywide health indicator. The intent was timely detection of public health events, with particular emphasis on influenzalike illness.
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From page 187... ...
Sandia National Laboratory Rapid Syndrome Validation Project (RSVPJ The RSVP is an Internet-based reporting system, intended for daily routine use by physicians and epidemiologists. The system features rapid data input of clinical and demographic information via a touch sensitive monitor, automated screening of reports for signs and symptoms correlated with reportable diseases and subsequent instantaneous notification of public health officials if indicated, and rapid feedback to clinicians of the geographic and temporal distribution of recent similar syndromes in their community in recent weeks.
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New health indicator surveillance systems for military communities should cooperate with civilian public health personnel since disease outbreaks do not respect military installation boundaries.
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A surveillance system will include data on animal morbidity and mortality to achieve the greatest sensitivity. Key Issues for Developing a Surveillance System Data Sources Health indicator surveillance is the foundation for early recognition of an emerging infectious disease.
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Resolving these issues will require high-level leadership, commitment, and prioritization. The following questions addressed the usefulness of health surveillance data.
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From page 191... ...
The Need for a System of Systems Ideally, a surveillance system will be sensitive enough to identify the emergence of an outbreak, categorize its nature, and identify those affected so that the outbreak can be quickly and effectively contained. Bringing together information from various health indicator data sets can allow the public health practitioner to 1)
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~6 large geographic area Southwest US Cultural concerns Zoonotic Salmonellosis Oregon, 1984, US, 1993 Encephalitis (West Nile virus) New York City, 19998 9 Bioterrorism attack that mimics naturally-occurring outbreak Unrecognized as bioterrorism at time Community-wide outbreak Common agent Zoonotic (birds are first victims)
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SCIENTIFIC AND POLICY TOOLS FOR COUNTERING BIOTERRORISM 193 TABLE 6-2 Possible sources of health indicator surveillance data Data Source Pros Cons and Confounders Outpatient and ER visits Reflects incidence of dis ease in general popula tion ICU diagnoses Best indicator of rare OTC pharmacy sales Clinical lab submissions Medicare or Medicaid claims Nursing homes Systematic testing for specific disease agents of specimens submitted to public health lab School and work absenteeism Ambulance call chief complaints Poison info calls HMO/Nurse hotline calls Nonspecific- May be difficult to document definitive information Will not capture milder events like West Nile virus or Hantavirus pulmonary syndrome Reflects symptomatology most broadly Ordered by clinicians Ease of data capture Reported by medical personnel Immobile population with limited exposure possibilities Specificity of diagnoses May occur earlier than visits to clinician Many communities with timely access to data Ability to access real-time cases Subject to promotions/sales Nonspecific May not be ordered for all (most) patients Problems with timeliness and accuracy Not broadly representative Immobility reduces exposure potential Not broadly representative Broad screening not likely to capture meaningful data Difficulty getting information on positive samples Not timely May be absent for nonmedical reasons Delays in obtaining data Non-specific May not be related to infectious diseases Occur very early in disease May be difficult to catego outbreak rize
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lo ~ lo lo ~ ho l lo ~ lo Hi ~ en o o o o ~ - ~ - ~ - ~ Q Q Q Q ~ ~ Q Q O O Q Q flu A_ of.
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From page 197... ...
My own experience in collaborations with computer scientists at the Navy Center for Applied Research in Artificial Intelligence has lead me to realize that computational approaches can productively be used to analyze and conceptualize the behavior of epidemic microbes. I suggest that we are fast approaching an era in which we will use computational modeling and simulation to guide public health policy decisions with regards to emerging infectious diseases and bioterrorism.
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Such computational power could permit simulation of infectious disease epidemics with realistic features. Computational modeling and simulation should be an important new area for initiatives in our efforts to confront emerging infectious diseases and bioterrorism.
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Environmental detection requires rapid, semi-automated methods that enable detection of a broad spectrum of potential biological agents. These methods need to be standardized, rigorous, reproducible, and based on a thorough understanding of the natural background.
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They are based on the same technologies as the environmental detection assays and work reasonably well in fairly idealized conditions. Their use is based on clinical suspicion, they are not generally used for automated implementation based upon broader or less specific information.
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. The diversity of potential bioterrorist agents present a major challenge.
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. We need high throughput laboratories with much greater surge capacity.
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Investments aimed at protecting against bioterrorism are best harmonized with the overall efforts to combat infectious diseases. Outbreaks of infectious diseases, whether naturally occurring or intentionally initiated, can represent threats to national and global security.
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Broad spectrum antibacterials and antivirals could offer protection against a wide variety of infectious agents and could offer major protection against bioterrorism this would offer broad protection against unknown biothreat agents while specific narrower spectrum drugs would be most appropriate when the exact nature of an agent had been determined. Ensuring the vigor of research and development efforts to combat infectious diseases, with an appropriate focus on biothreats, will require an influx of new investments and the strategic redirection of some ongoing efforts through reallocation.
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From page 205... ...
ASM has supported imposing reasonable restrictions on access to select agents that pose high risks as potential biological weapons. It has supported legislation and regulation that control the exchange of certain dangerous pathogens including the CDC Laboratory Registration/Select Agent Transfer Program These regulations, which place shipping and handling requirements on laboratory facilities that transfer or receive select agents capable of causing substantial harm to human health, are designed to ensure that select agents are not shipped to parties who are not equipped to handle them appropriately or who lack proper authorization for their requests.
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From page 206... ...
Background checks would have to be conducted and steps might also be mandated to ensure that law enforcement could prevent suspected terrorists from gaining access to select agents. Appropriate security requirements for persons possessing, using, or transferring biological agents and toxins would be imposed and information would have to be provided, if available, that would facilitate the traceability of select agents if those agents were ever misused.
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From page 207... ...
It also meant multiple antibiotic treatment was warranted in cases of inhalational anthrax. Thus did it present information useful to the biomedical community.
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Thus, it may be much more simple to create more virulent biothreat agents than previously thought again raising the question of whether such information should have been revealed? Should journals censor such information in such articles?
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In my view, the scientific community must move forward as quickly as possible in eliminating the threat of bioterrorism by finding effective preventative measures and cures so that infectious diseases are not a credible threat to humanity. Beyond the obvious need to further biomedical research and to strengthen the public health infrastructure, one can ask about the appropriate role of the scientific community in identifying misconduct.
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The best defense against anthrax or any other infectious disease is information information in a form that can be used by scientists and by members of the public to guide rational and effective actions to ensure public safety. Placing major new barriers in the path of the flow of information between scientists and between scientists and the public more likely may ultimately contribute to terrorism by interfering with our ability to prepare and to respond to the threat of the misuse of science by bioterrorists." COORDINATING THE INTELLIGENCE, PUBLIC HEALTH, AND RESEARCH COMMUNITIES Craig Watch Federal Bureau of Investigation An intentional biological terrorism event requires a law enforcement response.
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From page 211... ...
Associate Professor, School of Public Health University of California, Los Angeles Homeland Security and the Biological Weapons Convention The United States must control bioweapons threats on two major fronts. Domestically, it must seek new ways to boost homeland security and respond to terrorists attacks in several American cities.
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From page 212... ...
Molecular Forensics The United States, the world's leader in biotechnology, is in a position to create a new kind of high-throughput molecular forensics laboratory against bioweapons agents. Optimally, there would be two such facilities.
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From page 213... ...
Available Technologies All the necessary technologies are available to build and operate a highthroughput molecular forensics laboratory and database system against bioweapons agents (Layne et al., 2001~. More than a hundred companies manufacture the necessary equipment, which generally consist of flexible "plug-andwork" modules, and such technologies are often integrated into one of two kinds of system designs.
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But the United States has few well-developed policies to deter biological attacks. A high-throughput molecular forensics laboratory and database facility would help to fill this gap by enabling a new policy of virtually assured detection and response (VADAR)
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A quantum leap in threat agent surveillance and data analysis is needed. In a bioattack on the United States, as few as 50 sickened people in one major city could stretch public health, emergency medical, and law enforcement services beyond local capabilities.
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The mission of this new national medical forensics and intelligence support laboratory would be to complement and cooperate with existing government agencies such as health, agriculture, emergency management, justice, defense, intelligence, and the national laboratories. It would support public health, law enforcement, and homeland security programs without usurping their long-established missions.
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RESEARCH AND THE PUBLIC HEALTH RESPONSE Eric Eisenstadt, Ph.D. Defense Advanced Research Projects Agency Technology could help public health enormously, but to help focus the development of technology for public health (as well as for the FBI and other law enforcement agencies who cope with forensic issues that resemble the diagnostic ones faced by public health)
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For example, why not identify as a national goal the removal of infectious disease as a public health threat? This does not mean that we need to define how to eliminate infectious disease.
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2001. Innovative Surveillance Methods for Rapid Detection of Emerging Infections The Results of an Inter-Agency Workshop on Health Indicator Surveillance.
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