Shall We Play A Game?

How about global biological war?

Late last week, Newt Gingrich testified before the House Government Reform Technology Subcommittee on the public health system’s use of information technology to defend against and respond to terror.

Yesterday, Tom Ridge engaged in a tabletop exercise with the nation’s Governors, simulating a biological attack on the United States.

This morning, President Bush signed into law S.15, the Project Bioshield Act of 2004, which sets aside billions of dollars for the development and stockpiling of vaccines for bioterrorism agents, such as anthrax and smallpox (a/k/a lots of money to Bush’s Big Pharma Buddies).

All this, and anonymous rumors of sock stuffing just hours before the 9/11 commission report comes out! How about that.

Tabletop exercises and Rose Garden signing ceremonies make for pretty decent special effects, but in the case of bioterrorism preparedness, when you look behind the curtain, it becomes clear that the Administration’s committment has very little brains, heart or courage.

That’s because, thanks to the Administration’s efforts (or lack thereof), the first responders can’t get the equipment they need to respond…

Republican Mitt Romney of Massachusetts, who headed a task force that identified the weaknesses of homeland security from the perspective of state and local officials, said there continues to be a problem with getting federal money quickly to front line responders.

Romney said it was a problem at all levels, federal, state and local, but some Democrats said the Bush administration could do more to ease administrative rules that require financially strapped local governments to buy equipment first, and then seek reimbursement.

“Many of our communities can’t afford to do that,” Napolitano said. “I’d give them a C-plus.” Democrat Jim Doyle of Wisconsin said: “It’s created a kind of bottleneck, when everyone points fingers at everyone.”

…and after 3 years, there’s still not enough support to have in place an infrastructure that would allow for a coordinated, rapid response to an attack…

“Paper kills,” Gingrich told the House Government Reform Technology Subcommittee. “Paper prescriptions kill. Paper records kill. And if there’s a public health emergency, paper will kill a lot of people,” he said.
….
In the case of a major nuclear event, he said, officials would need to mobilize every nursing home and long-term care facility as well as every veterinarian’s office, “because all the downtown hospitals will be gone.”
….
“I can’t understate the importance of forcing [the Congressional Budget Office] and [the Office of Management and Budget] to calculate what we’re wasting now” with paper-based records systems.

…and there is just not enough commitment to getting the necessary funding to our cities and states to administer all the vaccines we’re buying…

Another metropolitan area agency noted that the percentage of funds it received from the state was inadequate in relation to the proportion of the state’s population for which that metro area health department was responsible. While the urban area overseen by the agency comprises almost 40
percent of the state’s population, the health department received only 12 percent of the state’s grant money. This limited the range of activities the urban department was able to underwrite. Local officials were dismayed to find that at, the end of the fiscal year, CDC funding remained unspent at the state level.

The disparities between the percentages of population that the metro areas are responsible for and the percentages of resources they are receiving are large….
The estimated percentages of their state’s population living in the selected metropolitan areas ranged from 9.1 percent to 29 percent (daytime percentages run even higher). In contrast, the estimated percent of state CDC bioterrorism funding received in the large metropolitan areas ranged from 4.9 percent to 12.8 percent.

(if those vaccines are even the right vaccines).

On January 14th, the team arrived at Vector, the main virology complex, in Siberia, and the next day, after being treated to vodka and piles of caviar, they were shown into a laboratory called Building 6, where one of the inspectors, David Kelly, took a technician aside and asked him what virus they had been working with. The technician said that they had been working with smallpox. Kelly repeated the question three times. Three times, he asked the technician, “You mean you were working with Variola major?” and he emphasized to the technician that his answer was very important. The technician responded emphatically that it was Variola major. Kelly says that his interpreter was the best Russian interpreter the British government has. “There was no ambiguity,” Kelly says.
….

Then they went upstairs into Building 6, and entered a long corridor. On one side was a line of glass windows looking in on a giant airtight steel chamber of a type known as a dynamic aerosol test chamber. The device is for testing bioweapons. …

The inspectors asked to put on spacesuits and to go inside. (They had brought along Q-Tip-like swab kits: they would have liked to swab the inner walls of the chamber, in the hope of collecting a virus.) The Russians refused. “They said our vaccines might not protect us,” Malinoski says. “It suggested that they had developed viruses that were resistant to American vaccines.” The Russians ordered the inspectors to leave Building 6.

Absent remedying the nation’s public health infrastructure problems, these PR events by the Administration are kind of like, oh, I don’t know, expecting that a small Army armed to the teeth with high-tech gadgets will have the capacity to maintain order and establish a safe, peaceful democracy in a foreign land.

Last July, my colleague and I had an opportunity to write an editorial on these issues in the journal Science.

More prudent would be an emphasis on providing the manpower and capacities necessary for the public health system to monitor for potential outbreaks…. While inadequacies in basic public health programs such as surveillance and monitoring remain, however, it is these basic public health functions that should get priority.

It is not insignificant that funding that prioritizes basic public health infrastructure promises benefits beyond bioterror defense. Strengthening the CDC’s ability to monitor disease outbreak, for example, benefits the nation’s health and safety even in the absence of a bioterror threat. Likewise, strengthening the capacity of hospitals and emergency services promises benefits for our nation’s ability to respond to non-terror related emergencies. Changing priorities to strengthening the basic public health infrastructure, then, has the rare and happy feature of promoting national interests in bio-terror defense, and non-terror related interests in promoting the health of the population. Even if our sole concern is with bioterror defense, however, current projects to address biological attacks are merely window dressing in the absence of a strong public health infrastructure that possesses the capacity to implement bioterror response.

Unfortunately, one year later, the Administration’s war games have not moved us far enough down the path toward preparedness.

While the 9/11 Commission may not point fingers in its report tomorrow, should this inevitable attack Tom Ridge keeps talking about happen to be bioterror, I’m afraid we’ll not only have failed to stop the attack, but also we’ll likely fail to keep the attack from becoming far worse than it might have been, had investments been more wisely made in our infrastructure. And we’ll know exactly who to point the fingers at then.