Biodefense report card says US still unprepared

Oct 12, 2011 (CIDRAP News) – Though the United States has improved its ability to respond to small-scale bioterror events, it is still unprepared to protect its citizens against large attacks, according to the latest assessment today from a bipartisan commission established to advise Congress.

The 73-page review was conducted by the WMD Terrorism Research Center, a nonprofit group based in Washington, DC, that was founded in 2010 after the Congressional Commission on the Prevention of Weapons of Mass Destruction completed its work. In January 2010 the commission published a similar but shorter review that gave the government an "F" for its lack of efforts to improve the country's capacity to respond to a biological attack.

Though the new report issues letter grades, many of them Ds and Fs, across a range of response categories for different levels of biological events, it said readers should use them as a quick reference guide, not to calculate a grade point average. The WMD Center is chaired by two former Senators who served on the Congressional WMD commission, Bob Graham, a Democrat from Florida, and Jim Talent, a Republican from Missouri.

An 11-member advisory board led the center's assessment, which focuses on eight bioresponse categories: detection and diagnosis, attribution, communication, medical countermeasure availability, medical countermeasure development and approval, medical countermeasure dispensing, medical management, and environmental cleanup. For each category, the report includes a set of questions designed for use as metrics to assess different capabilities.

The report's scale of biologic events ranges from small noncontagious events such as the anthrax letter attacks in 2001 to a global crisis, such as the one recently depicted in the movie Contagion.

The group's review also provides an overview of current and emerging biological threats, spells out challenges and expectations for each of the eight bioresponse categories, and recommends priorities for strengthening the nation's preparedness and response capacities.

Though naturally occurring diseases remain a threat, others such as drug-resistant pathogens and synthetically engineered organisms represent growing concerns. "Modern biotechnology provides small groups with the capabilities for a game-changing bio-attack previously reserved for nation-states," the group wrote.

In several parts of the report, the group wrote that funding shortfalls are threatening progress, for example, on disease surveillance at the local and state levels. Although the nation gets a grade of "C" for detecting a small-scale noncontagious or contagious event, a large-scale attack would overwhelm existing capabilities, according to the report.

Attribution—assigning responsibility to the group responsible for the attack—is vital for stopping or minimizing attacks, according to the report. But the nation still doesn't have scientifically and legally validated capabilities, which led to low marks across all of the threat levels. However, the group noted that the Centers for Disease Control and Prevention (CDC) and the Federal Bureau of Investigation (FBI) have made considerable progress in building partnerships between public health and law enforcement.

One area that received relatively good marks—B's for small-scale events and C's for larger ones—was communication before, during, and after a biological event. Most of the positive findings came from the government's planning for and response to influenza pandemics and feedback from the public that the CDC's communications during the 2009 H1N1 pandemic were successful in reaching most audiences.

The group said public health officials are making better use of innovative mobile technology and social networking tools, such as the CDC's "Zombie Apocalypse" campaign that promoted all-hazards preparedness.

When the experts assessed medical countermeasure development and production, they found that current stockpiles could limit the impact of small-scale attacks but would be insufficient in a larger attack or even nonexistent if an attack involved a drug-resistant or novel pathogen.

The nation's system for developing and acquiring medical countermeasures lacks clearly defined requirements, common research and development goals, coordinated budget requests, and enough sustained funding, the group said. Though the Biomedical Advanced Research and Development Authority (BARDA) started off with strong financial support, it is currently funded at about 10% of its requirements, the report estimated, and the Food and Drug Administration (FDA) lacks funding for its work on medical countermeasures.

"Without sustained funding there will be little chance of success," the experts wrote. "Medical countermeasures are the most important arrow in the biodefense quiver."

When it comes to distributing the medical countermeasures in an attack setting, government capabilities also fall short for large-scale attacks. Dispensing antibiotics to a large population within 48 hours of attack is highly unlikely. Though federal officials have made progress in helping local departments, the experts called it slow and uneven. "Meeting the 48-hour standard will not be possible without multiple and redundant dispensing strategies," they wrote.

In the medical management and response category, the panel said that a catastrophic event would quickly overwhelm the medical system, and though some progress has been made over the last 10 years, the nation still lacks a comprehensive approach to emergency medical response. The group pointed out that the federal government has yet to coordinate its own medical resources, such as the Veteran's Administration and the Department of Defense.

The section on environmental cleanup mainly focuses on the anthrax threat. Although the government recently released interim guidance on remediation after a wide-area anthrax attack, it doesn't address questions such as evacuation and long-term health issues, the report said. Other gaps include a lack of policies to establish outdoor and indoor cleanup safety standards or policies to define who bears the cleanup responsibility and cost.

In its recommendations for improving bioterror preparedness and response, the group urged policymakers to focus not just on areas that received failing grades, but to focus on the more likely large-scale events, which lie in the central part of the threat event range. They emphasize that it's possible to improve this area in the relative near-term, and the actions would likely improve the grades for small-scale events.

The group said improving the nation's biodefense capabilities should focus on three areas: leadership, mobilizing the nation, and sustaining investments in science.

"Too few leaders in government or the private sector fully understand the growing threat of bioterrorism—and its potential consequences," they warned. Though focusing on relatively unknown threats is challenging, small inexpensive steps could have a big impact, they noted. For example, the Office of Management and Budget could illustrate the biodefense budget like it does for cybersecurity and nuclear security, which might help Congress make more informed decisions on biodefense spending and priorities.

Over the past decade the nation has made significant strides in engaging all sectors of society to improve emergency preparedness and response, according to the report, which pointed out that a bioterrorism attack poses some unique threats that aren't addressed by the all-hazards approach.

"In an era of economic instability and budget constraints, it has never been more important to identify and mobilize the nation's collective capabilities and resources," the group wrote. Its members urged the government to address legal and regulatory barriers that block coordination with other groups and the private sector.

The experts, citing federal budget constraints, urged federal officials to focus investments in bioresponse science toward areas that are likely to have the greatest impact, including medical countermeasures and regulatory science, environmental remediation, and bioforensics research.

They warned policy makers that the FDA can't build a successful countermeasure program with 1-year funding, with support that varies from year to year. "Priority must be placed on creating long-term funding of FDA research, the same way the Department of Defense provides long-term funding for weapons development."

See also:

Oct 12 WMD Terrorism Research Center Bio-Response Report Card

Jan 26, 2010, CIDRAP News story "Report: US flunks on ability to blunt bio attack"

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