Bioterrorism Preparedness

Reports, symposia proliferate; government, healthcare system readiness insufficient

Eugene Russo / The Scientist 15[1]:1,    8jan01

Although the world has yet to witness a major bioterrorist attack, the field of bioterrorism continues to capture the attention of scientists, policy makers, and public health professionals. Symposia and reports are commonplace, and relevant legislation recently made it through Congress.

Two upcoming government reports reaffirm a bioterrorism preparedness problem and recommend remedies. One comes from the Department of Defense (DOD) Threat Reduction Advisory Committee (TRAC), the other from the Defense Science Board (DSB), a federal advisory committee established to provide independent advice to the secretary of defense. Parts of each report will be classified; both are due out later this year.

According to TRAC report author Joshua Lederberg, president emeritus of Rockefeller University and chairman of the editorial advisory board of The Scientist, the paper tries to clarify the biodefense role of the DOD and other government agencies. According to George Poste, CEO of the Gilbertsville, Pa.-based Health Technology Networks and chairman of the DSB's panel, the DSB report will focus in part on how to improve the speed, breadth, and accuracy of clinical diagnosis for bioweapons-related attacks. It will also address the growing need for new vaccines and therapeutics.

Also due out early this year is a report from the Washington, D.C.-based Center for Strategic and International Studies (CSIS), a public policy think tank (www.csis.org). Another Washington-based public policy institute, the Henry L. Stimson Center, released a report in October 2000 that attempts to put the chemical and bioweapons threat "in proper perspective." The report outlines recommendations for a more coherent national strategy that better supports hospitals and better organizes government response (www.stimson.org/cwc/ataxia.htm).

Actual legislation that addresses bioterrorism is also in the works. Bill Frist (R-Tenn.) and Ted Kennedy (D-Mass.) have authored the "Public Health Threats and Emergencies Act." Part of a group of public health bills, the act aims to bolster funding, to improve the capacity of public health officials to deal with a bioterrorist attack or other modern disease threat, to shore up coordination of federal agencies, and to fortify the infrastructure of the nation's public health institutions--it asks that facilities at the Centers for Disease Control and Prevention (CDC), for example, be extensively modernized. Congress has approved the public health bills package, and President Bill Clinton signed it into law in early November 2000.

In late November, Sen. Kennedy expounded on the law to researchers, policy makers, public health officials, and members of the military at a two-day symposium on bioterrorism and bioweapons--"The Second National Symposium on Medical and Public Health Response to Bioterrorism." The November meeting was a follow-up to the first major bioterrorism symposium in February 1999.¹ Both symposia were sponsored by, among others, the Johns Hopkins Center for Civilian Biodefense, the U.S. Department of Health and Human Services, and the Infectious Disease Society of America. And both symposia examined the dangers of bioweapons, the availability of the technology, and the nation's lack of preparedness in the event of a bioterrorist attack.

D.A. Henderson, director of the Center for Civilian Biodefense, smallpox expert, and symposium moderator, suggested that although the intent of the first symposium was to increase awareness (chemical weapons have traditionally commanded more attention than bioweapons), the intent of the second symposium was to focus more closely on healthcare system preparedness and issues of surveillance at the national and international level. Henderson says he is encouraged by the CDC's increased interest in bioterrorism in the past year.

At the latest meeting, CDC director Jeffrey Koplan elaborated on the agency's efforts, noting that over $275 million was appropriated for bioterrorism preparedness activities in 1999 and 2000. Aside from supporting pharmaceutical stockpiles, most of the funds were awarded extramurally for state and local bioterrorism efforts, including disease trend and outbreak-detecting information systems, such as the National Electronic Disease Surveillance System.

Yet the most pressing problem, maintains Henderson, continues to be the complete lack of bioterrorist attack preparation or funding at the nation's already financially strapped hospitals. According to statistics cited by Sen. Kennedy, 87 percent of hospitals have an inadequate supply of medications needed in the event of a bioterrorist attack or other infectious disease emergency; in some hospitals more than 90 percent of the doctors have received no training in recognizing the symptoms of biological weapon exposure.

Mock bioterrorism attack scenarios have been staged to discover how best to train and prepare those in charge. Both the 1999 and the 2000 symposium held sessions in which leaders from government, medicine, and public health responded to a detailed, simulated, bioterrorist attack scenario, attempting to elucidate ways of dealing with the expected ensuing chaos. A larger scale simulated attack took place in May 2000, an exercise called TOPOFF (named for the engagement of top officials of the U.S. government). The $3 million drill, directed by the U.S. Department of Justice, sought to highlight public health system weak spots by simultaneously presenting a mock chemical weapons event in Portsmouth, N.H., a radiological event in Washington, and a bioweapons event in Denver (the release of an aerosol of Yersinia pestis, the bacteria that causes plague). The exercise suggested that both healthcare facilities and local and state public health agencies are poorly prepared for such attacks. For example, push packages, a pre-assembled set of supplies, pharmaceuticals, and medical equipment intended for emergency delivery within 12 hours, arrived at the desired locations on time but were not efficiently broken down and distributed within the community.

Biotechnology's Dark Side

The science of bioterrorism is as complex as potential attack scenarios. Fueled by biotechnological advances, the sophistication of bioterrorist agents could potentially go well beyond something such as plague used in TOPOFF. Speaking at the November symposium, Poste explained how recent, seemingly beneficent biotechnological innovations have a potentially dangerous flip side that should be carefully monitored.²

"Biology for the first time is losing its innocence," said Poste. "If you speak to many in the biomedical community ... they're quite shocked to think that some of the things they've been working on could have malignant applications." For example, the same research that seeks gene therapy viral vectors capable of evading immune system detection to prolong effectiveness could conceivably lay the groundwork for a stealthy bioterrorist agent.

Poste also cited the possibility of using the body's own defense mechanisms against itself by engineering organisms that produce excessive lymphokine and cytokine responses to induce shock syndromes. Equally sadistic, a seemingly dormant virus is shuttled into the body with a bacterium; the virus only proceeds to wreak havoc when the patient is treated with antibiotics. What Poste called the most sinister scenario is a latent agent integrated into the target's genome that's only activated "when you presume that the political ideology of your opponent has become sufficiently offensive."

"This is not a national U.S. problem. This is a species problem," says Matthew Meselson, co-director of the Harvard Sussex Program on Chemical and Biological Warfare Armament and Arms Limitation. "The weapons we've dealt with in our past don't change what it means to be a human being." Keeping a lid on bioterrorism technologies is a daunting challenge, comments Meselson, considering mankind's track record: society has eventually exploited every new technology, from metallurgy, to avionics, to computing, to nuclear power. Says Meselson, "Everything has been used not only for peaceful purposes, but also very energetically for hostile purposes." 

Eugene Russo can be contacted at erusso@the-scientist.com 

References

1. E. Russo, "Bioterrorism Concerns Heightened," The Scientist, 13[6]:1, March 15, 1999.

2. R. Lewis, "Bioweapons Research Proliferates," The Scientist 12[9]:1, Apr. 27, 1998.

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