Biological Threats and Terrorism Assessing the Science and Response Capabilities: Workshop Summary (2002) / Chapter Skim
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Summary and Assessment
Summary and Assessment
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There was much debate, however, on what constitutes an appropriate framework to deliver this message. No matter how the issue is cast, numerous workshop participants agreed that there are many gaps in the public health infrastructure and countermeasure capabilities that must be filled in order to assure a rapid and effective response to another bioterrorist attack.
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It is impossible for us as a nation to provide a specific defense against each of these many agents within a reasonable time frame: the diversity of readily available potential bioterrorist agents is great, the technology and knowledge that make it possible to bioengineer drug- and vaccine-resistant antimicrobial strains are becoming increasingly accessible, there are many crucial gaps in our countermeasures and public health response capabilities, and it was noted that one can develop a new bioweapon within only two to three years compared to the eight to ten years that it typically takes to bring a new vaccine or antimicrobial product into the market. It is possible, however, to bolster our nation's general biodefense to a level at which we can at least minimize, if not prevent, the potentially catastrophic consequences of a large-scale bioterrorist attack.
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Workshop participants recognized that now might be an opportune moment to foster better understanding of what has been in the past decade an often unheard call in the interest of public health, from increasing infectious disease surveillance to confronting antimicrobial resistance. It was proposed that an alternative strategy would be to address bioterrorism response preparedness in a coordinated fashion with broad emerging infectious disease issues.
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And, whether the issue is framed solely as a national security threat or as a national security threat with concurrent benefits for the public health infrastructure, it must be stressed that in no way should efforts toward bioterrorism preparedness diminish other specific public health programs. Finally, as one workshop participant indicated, framing the issue involves more than wrapping words around it.
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It was mentioned that significant amounts of untapped laboratory capacity and scientific expertise exist within the global pharmaceutical industry in particular. It was suggested that a better way to leverage that capacity be devised by recognizing that industry truly is a partner in public health and able to contribute in very substantial ways to sustainable vaccine and drug research and development.
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· Craft innovative mechanisms and channels for forming and strengthening partnerships required for an effective response. · Evaluate the necessity of a legal strategy for bioterrorism response.
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Response infrastructure involves communications and information, laboratory capacity, disease detection and surveillance, and local response. Additional individual priorities are identified in the authored papers that follow in subsequent chapters of this report.
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Discussion of other priorities related to vaccine development and production included the consideration of alternate methods of vaccine administration that would be more amenable to rapid dispersion, such as oral or inhalational vaccines, applications of genomics and high throughput technology in the identification of genomic markers for vaccine efficacy, technological applications that would improve vaccines, the use of combination vaccines, the potential applications of the new DNA vaccination technology, and, the application of military data on vaccine use to civilian populations. One participant noted that is was important to recognize the inherent differences between military and civilian bioweapons defense vaccine usage and develop a specific vaccination policy for bioweapons defense in the civilian population.
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· Explore the potential for monoclonal and polyclonal human antibodies as countermeasures to bioterrorist agents and provide incentives to encourage development. · Direct more effort toward alternative antiviral therapeutics, such as immunomodulators.
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Examples of the type of knowledge that is needed and that can be gleaned from basic research include a better understanding of microbial biology, the human body's innate immunity, the potential applications of computational techniques and infectious disease modeling, and aerosol biology. Funding for basic scientific research, as well as for research associated with the development of new vaccines and therapeutics, must extend beyond the actual experimental work.
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· Increase operational systems research that addresses whether preparedness plans are working. · Consider the role of computational modeling in bioterrorism response preparedness efforts.
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in particular was suggested in order to ensure rapid dissemination of crucial information. Some specific priorities for improving public communication and information policy were identified by workshop participants.
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For example, CDC laboratories were stretched to the limit with recent events, building a temporary level A laboratory to do ground-level screening when such work might have been delegated to other established level A facilities. Workshop speakers called for more serious consideration of the extent to which the public health laboratory response network can and should interact with other laboratory systems around the country, especially veterinary diagnostic labs and particularly the National Veterinary Services Laboratory, which is generally considered to be the CDC of the veterinary world.
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Individual participants urged the following steps to action: · Educate front line healthcare providers so that the astute laboratory clinician, nurse, or doctor who sees the first patient or wave of patients can recognize an attack early and sound the alarm. · Develop a sustainable, standardized information-gathering database which is shared among labs and which the CDC can access.
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A strong local response involves not only local public health agencies, but also hospitals, the law enforcement community, and the community at large. It was observed that there is a striking disparity in public health capacity not only among states but also among jurisdictions within states.
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· Strengthen local medical care surge capacity, including personnel, training, space, supplies, and equipment. · Consider the usefulness of joint training and preparedness exercises among local public health departments and hospitals.
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The need to open international doors to build bridges and allow for a broader international dialogue regarding bioterrorism and civilian defense measures was proposed by several participants. For example, one speaker noted that it was extraordinarily unfortunate that initial information about what actually happened during the unintentional release of anthrax at the Soviet biological research complex in Sverdlovsk in 1979 was not readily available when officials first began to address the recent anthrax outbreak in the United States.
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On the other hand another participant noted, if the former Soviet Union's bioweapons program involved thirty agents and we are only dealing with a list of five or six, there is a large gap between what could happen and for what we are prepared. The question was also raised, would it be possible to clear a select group of people to access the Department of Defense's classified library of our former offensive biological warfare program?
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An increased public awareness may help overcome the challenge of convincing those who allocate resources that new and substantial resources are needed at all levels of capacity-building, from multi-sector collaborative vaccine production to informed local first responders. Several workshop participants expressed the belief that increased public awareness will indirectly send the message to Congress that this is a serious issue that demands immediate attention.
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