Will We Be Prepared for Biological Threats?
On Sept. 11, 2001, America was caught unguarded against the machinations of a ruthless terrorist organization. Only four years later, the Gulf Coast was devastated by nature's wrath when Hurricanes Katrina and Rita crashed our shores. The horrific events that have hallmarked this young 21st century of American history leave many imagining what the next threat will be and whether the federal government will be fully prepared to respond.
U.S. Health and Human Services Secretary Michael Leavitt left little to the imagination when he warned a Senate panel on March 1 that the arrival of avian flu in America is "just a matter of time - it may be very soon." Less than a week later, Leavitt authorized a new plan for vaccination development - a departure from the Bush administration's previous inaction to develop new vaccines.
A warning has been issued this time, but will we be ready?
The effects of a biological incident could be crippling. It is a threat that can occur naturally, as did the hurricanes, or be weaponized to serve the deadly intent of our enemies. In either case, biosecurity is critical to prevent an incident that may dwarf the losses endured by the American people and economy during the past five years.
My work as the ranking member on the Homeland Security subcommittee on emergency preparedness, science and technology and my assignment on the subcommittee on aviation leaves me with a discouraging outlook. Despite passing the Project Bioshield Act of 2004 to protect and mitigate the effects of a biological incident, the state of our public health infrastructure remains inadequate to respond to a large-scale episode.
Project Bioshield has successfully funded treatments for threats that are easily weaponized such as anthrax, small pox and radiological sicknesses, but it has fallen short of addressing our imminent need for rapid vaccine development to manage an avian flu outbreak. Avian flu does not even rank as a threat under the jurisdiction of Bioshield, indicating that the administration has underestimated the power of a potential naturally occurring biological incident.
The "Spanish Flu" epidemic of 1918-20 is believed by experts to be a good model for what may soon forcefully confront the global community. That flu killed 20 million people worldwide, including 675,000 Americans. Projections from the Center for Infectious Disease Research and Policy estimate 180 million to 300 million deaths worldwide, including more than 1.7 million in America if the approaching avian flu becomes an epidemic.
So what do we do?
First and undoubtedly foremost, we expand our support of a strong domestic manufacturing base for vaccination production. Simply creating a massive stockpile will not be sufficient. Avian flu's ability to mutate creates an evolving threat that may demand a series of rapid countermeasures. With only one manufacturer of injectable flu vaccine located in the United States, rapid mass production and distribution during a pandemic would be an impossible task.
The creation of a stronger domestic manufacturing base for vaccinations depends on the pharmaceutical industry's ability to research and develop the appropriate medical treatment. The federal government must create a more strategic partnership with private sector manufacturers to assist in the cost of research and development. It is essential that the gap between our public health needs and the load drug manufactures are able to produce be bridged.
Second, when faced with a global threat, global cooperation is essential. We must anticipate infections and work with countries that already have experienced infections. This is currently not the case, as the government of China failed to release the most recent flu samples, limiting the opportunity of other nations to create, research and develop countermeasures.
Third, we must stockpile antiviral treatments. Without a substantial supply of vaccination, antiviral medication will be relied on to mitigate the effects of an outbreak. I commend the work one pharmaceutical company is doing with the Department of Health and Human Services to add a manufacturing site in the United States. The same company's donation of three million courses of Tamiflu to the World Health Organization also aligns with the type of international and public-private relationship we need to stifle the flu's spread.
Fourth, we must prepare our hospitals and emergency medical personnel for the large influx of patients that would occur during an avian flu outbreak or a biological attack. Personnel must be equipped, trained and prepared to educate the public on the most basic preventative health standards.
Fifth, we need connectivity at every level. I cannot stress this enough. Officials in the federal government must have the ability to communicate laterally between agencies. Biointelligence and biosurveillance must be developed and shared between the departments of Health and Human Services, Homeland Security, the Centers for Disease Control and Prevention, and the National Institutes of Health, just to name a few.
Equally important is that these communications be shared with those who have their boots on the ground, our state and local governments.
Bioshield must be fixed or replaced with a program that takes naturally occurring incidents seriously and invests more in vaccination production. Until that happens, it is essential that the federal government implement an "all hazards" approach to a biological incident of the worst case scenario, be it man-made or natural.