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.…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…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.”
“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. ….…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…
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.
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….(if those vaccines are even the right vaccines).
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.
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. ….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.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.
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.
Seems to me if we were serious we would be (1) vaccinating everyone for smallpox {perhaps asking the Russians for help selecting the best vaccine} (2) developing a usable anthrax vaccine and, again, vaccinating everyone. I am just a stupid engineer, but it seems that those two steps would increase the difficulty of mounting a bioterrorism attack by at least 3x.
But three years after the post-9/11 anthrax attacks and we haven’t heard word one about a new anthrax vaccine.
Cranky
I don’t know how much you’ve worked in government, but the issues you describe are typically dealt with way below the policy-making level, so it would be very silly to expect a different administration to produce change. I have worked for both Democrats and Republicans, and there isn’t much difference on these types of issues. Your post kind of suggests that you are under the impression that the President personally designs the reimbursement procedures for each individual federal program, which I hope you realize isn’t the way it works.
Part of the reason why a universal smallpox vaccination program has not been carried out is that smallpox vaccination is not risk free.
As many as 300,000 people would suffer adverse side-effects from such a program (based on a US population of approx 300 million), several thousand would experience severe or life-threatening side effects and between 250 and 500 would die.
[these figures are vague and based on rough calculations on the figures in the article cited below]
The risk level is higher in populations that are particularly susceptible to side effects.
There’s a CDC summary on smallpox vaccination policy here:
http://www.bt.cdc.gov/agent/smallpox/vaccination/facts.asp
Smallpox vaccination would also not be cheap and the protection it offers is only for a period of a few years.
Additionally, smallpox vaccination can take place after exposure so maintaining stockpiles of vaccine would be almost as good as a program of widespread pre-emptive active vaccination.
It’s also my impression - from a non-US perspective - that the CDC maintains a pretty effective watch on these kinds of conditions so if an outbreak happened they would be able to react quickly. Of course that impression is just from reading newspapers so it might be wrong…
> Part of the reason why a universal
> smallpox vaccination program has
> not been carried out is that
> smallpox vaccination is not risk
> free.
Unfortunately, I don’t have time to write posts that are as complete as I would like. As I was hitting the POST button I realized I should have included something along the lines of “knowing what the risks are, we should still proceed with smallpox vaccination”.
The problem with the CDC assumptions and the ring vaccination program is that they are intended to handle the occasional traveller or immigant who exposes 5 or 10 people, and whose symptoms are recognized in time. If a deliberate attack infects, say, 500 people at an airport, those assumptions will not be valid. All our doctors, nurses, and EMTs could be dead before we figure out it is time to start ring vaccination.
Perhaps Ross could jump in here - it sounds as if he has more detailed technical knowledge.
Cranky
wsm,
Are you implying the issue of prioritization of major funding initiatives is not one on which the highest level of government plays a significant role? Bush has prioritized (and heavily promoted) BioShield and BioWatch, two high-tech, gee-whiz programs (Tommy Thompson has given reporters tours of his War Room-esque command post right across the hall from his office). And while it is true a Democrat might not handle the issue much differently if he were in charge, the infrastructure deficiencies were well and widely documented before 9/11 and after October ‘01 and the anthrax attacks, when, as our President likes to remind us whenever possible, “everything changed,” and it has happened on his watch.
Couldn’t we just play tic-tac-toe instead?
Also, the anthrax vacines that the US military has been testing on troops have numerous side effects, among them, restricted breathing (in some cases) but mostly shortness of temper. My sister in law is a Seargent in the Army, specilaizing in chemical warfare. She recieved the anthrax vacine and told me all about how everyone, including her, suddenly started loosing their temper over the slightest matters. A lab tech confirmed that this is one of the side effects. Now, grant it, crankiness is better than mass casualties, but when added to the stress of a biological attack by terrorists, the US would be looking at an awful lot of really pissed off people. That’s sure to effect election results.
> Also, the anthrax vacines that the
> US military has been testing on
> troops have numerous side effects,
Agreed - a family member developed a chronic illness that even the Army doctors admit may have been caused by the vaccine.
But that is just the point - that vaccine was developed in the 1920s. It is used because no drug company dares put another one through modern human certification trials. The vaccine used on horses is a lot safer (vets give it to themselves all the time), and I would have to think that if we put 00s biology techniques to work on the problem we could do better than in the 20s.
Cranky (not as a result of vaccine - just natural)
WSM-
There is extensive evidence that this admin is, in fact, different from its predecessors in terms of commitment to policy and implementation, as opposed to politics and publicization. Witness John Diullo (sp?), who is a Republican, and was familiar with how admins have traditionally worked. He was stunned at the “absence of a policy aparatus” [close paraphrase], and decried the absolute dominance of the Mayberry Machiavellis - political operatives putting political considerations first, last, and everywhere in between.
If there is NO interest at the top in proper policy development and implementation, then the bureaucracy will have no guidance, no impetus, and no incentive to do the right thing. To say otherwise is to say that because most generals operate about the same way, an army will be equally effective under any general, or indeed no general.
The reason that so many centrists (see Brad DeLong) are so angry at this admin is not that they have suddenly become left wingers (see BDL vs. Ehrenreich); it is that they are furious to see the government, which, Republican tropes to the contrary, runs as a professional and effective organization from administration to administration, run into the ground by a stunningly cynical and incompetent administration.
It’s not ideology that makes budget forecasts cover 5 years instead of 10; it’s a pathetic effort to hide the facts from the governed. It shouldn’t take an opposing ideology to find such acts troubling.
Vaccination is, to date, the best known weapon against an infectious disease bioterror attack. The decision to pursue any kind of preparation against such an attack enjoys overwhelming support from the people, if congressional support is any indication. There is considerable evidence in the literature that the efficacy of an attack is dependent on the susceptibility of the population. That’s not to imply that infrastructure is not important, it is made more important for reasons other than bioterror attacks. But in an approach to the possibility of a bioterror attack, the best method is still vaccination and a policy decision to be prepared for such an attack seems reasonable. Making light of a particular method against bioterror because of the potentially small risk of attackis mixing arguments. Optimization of the approach is an academic decision and is made with the imput of multiple segments of the health care community, including epidemiologists. Any medically optimal approach requires the purchase of vaccines from the companies that make them (not always “big pharma”—vaccines are also made by small companies).
Seperately, the recombinant anthrax vaccine is still in clinical trials, including some testing on military personnel. The adjunct vaccine is already required and comes with a considerable 1% risk of systemic side effects. New vaccines take 10-15 years from development to marketing. One of the intended effects of the new legislation is to speed this process.
It is not true that the vaccine used on horses is safer. It is an old vaccine based on live attenuated virus and it carries risk of actual anthrax complications.
eudoxis wrote: Making light of a particular method against bioterror because of the potentially small risk of attack is mixing arguments.
I’m not sure what you are saying… If you are talking about how to respond to a bioterror attack, of course the a priori risk is irrelevant: in the event of an attack, the risk is 1. But if you are talking about how to prepare for a potential attack, the risk of attack is very relevant, especially if some possible ways to prepare (such as mass smallpox vaccination with existing vaccines) come with considerable costs — thousands of cases of severe side effects and hundreds of deaths, according to a previous poster.
Considering the risk of attack is especially important for smallpox, since there are no known sources of smallpox virus accessible to terrorists or “rogue” states. (The openly known sources of smallpox virus are small stocks in the hands of the Russian and US health establishment. There is also the possiblity that there are stockpiles in the hands of the Russian military, although they are “said to have been destroyed”, according to one source. So the main risk of a smallpox attack that people are worried about is due to the possibility that either (1) another country or organization secretly isolated and stockpiled smallpox virus before 1977, or (2) some Soviet or Russian (or American, I suppose) scientist smuggled some smallpox virus to a terrorist organization or rogue state after 1977. Either of these are theoretical possibilities, but without some actual evidence that this happened, the risk off a smallpox attack would not seem to justify taking preventative steps that would kill hundreds of people. New intelligence could, of course, change this assessment….)
Alex R., my point is that when a decision is made that the risks of an attack are sufficiently high to warrant a response, that branch is pruned, even if the capacity to respond is built into that decision. Measure S.15 follows that decision and the approach (how to respond) in that measure aren’t properly critiqued on the basis of risk of attack.
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