Bioterror expert: Invest in med records, rapid tests
Bioterror expert: Invest in med records, rapid tests
Nation remains unprepared, but making progress
Seven years after the anthrax attacks jolted the nation and set off a wave of biodefense initiatives, the United States has a "highly disturbing" lack of readiness for attacks with biological agents, a leading bioterrorism expert recently told Congress.
"[Seven] years after anthrax was mailed to members of the U.S. Congress and to media organizations, the immediacy and potentially strategic significance of the bioweapons threat is not widely appreciated, nor is the country prepared to cope with the consequences of major bioattacks," Tara O'Toole, MD, MPH, director and CEO of the Center for Biosecurity of the University of Pittsburgh Medical Center, told the Senate Committee on Homeland Security and Governmental Affairs.
Though she gave credit to the recent major federal strategy changes to address the problems, O'Toole primarily warned about present inadequacies and imminent threats. For example, O'Toole argued for an investment in electronic health care records and rapid diagnostic tests as a practical alterative to over-relying on systems such as the Biowatch program, which uses environmental sensors to detect bioterrorism agents at major events and likely target areas.
"There is, I believe, a mistaken assumption that a great deal of health data will be available — for example, the number of people who are ill or admitted to hospitals with certain diagnoses or the availability and locale of critical resources such as available hospital beds, equipment, drugs, etc.," she told the committee at an October 2007 hearing. "But the health care industry is a decade behind the rest of the economy in digitalizing its business functions and the clinical side of health care. Thus, there are likely to be dangerous delays in gathering the basic information that will be needed to manage the crisis . . . Specifically, I would suggest that national investments in rapid diagnostic tests and in electronic health records and digital links between hospitals and public health agencies will yield more benefits — for both routine and emergency use—than additional investments in environmental sensors or syndromic surveillance technologies."
Terror regrouping
Ominously, recent analysis indicates that al-Qa'ida has regrouped to become stronger and more resilient and presents a greater threat to the United States than at any time since before 9/11, she said. "Key judgments of a July 2007 national intelligence estimate include the assessment that: 'al-Qa'ida will continue to try to acquire and employ chemical, biological, radiological or nuclear material in attacks and would not hesitate to use them,'" O'Toole testified. ". . . Yet, in spite of all these sobering reports and expert findings, progress in preparing the country to mitigate the consequences of a bioattack has been slow and modest."
In particular, O'Toole noted that the nation faces the following current realities:
There is no conduct of operations plan to guide national or local response to an anthrax attack.
The country has inadequate supplies of anthrax vaccine stockpiled; it would require years at present production capacity to produce enough to immunize the military or the civilian population.
Only a handful of cities or states could distribute materials from the Strategic National Stockpile in a timely manner.
The country is unprepared to cope with the medical demands of a mass casualty event.
There are no approved point-of-care diagnostic tests that physicians could use to diagnose (and rule out) anthrax or any other bioterror threat agent — this is critical in a context of scarce, potentially life-saving resources.
Should there be a covert biological attack on U.S. civilians, it is highly unlikely that the national command structure, or governors, or mayors would have even rudimentary situational awareness during a bioattack.
Agents will increase with tech gains
In addition, the BioShield program, created in 2004 to allow development and acquisition of essential medical countermeasures for the Strategic National Stockpile (SNS), is underfunded to meet the broad range of emerging threats, she said. Still, the program has $3.6 billion of the $5.6 billion appropriated in 2004. "[But] when one considers that the average cost of drug development is $800 million — and this is before a single pill or vaccine is purchased — it is obvious that $5.6 billion is not sufficient to protect the nation against the range of potential biothreats, let alone chemical, radiological, or nuclear threats," O'Toole argued.
The Department of Homeland Security released a biothreat assessment in 2006 that "identified more than a dozen pathogens, which, if released in a single attack, could plausibly kill thousands of people," she said. "It is important to understand that the number and variability of potential bioweapons agents will increase as bioengineering techniques become more accessible — this is happening at a rapid pace all over the globe."
The shift last year to development of more broad-spectrum countermeasures — which could be used to treat or prevent more than a single bioweapons agent – should help solve this problem, but we are playing catch-up, she noted. "This flexible defense strategy is a rational way to go, but it must be recognized that development of such new drugs traditionally takes 10 years or more," she said.
Moreover, medical countermeasures degrade over time — they have shelf lives and must be renewed periodically, she noted. The traditional approach to vaccine and drug manufacture is to build facilities dedicated to the production of a single product. FDA licensure is linked to approval of manufacturing processes in a particular plant for a particular product, she said. "For many of the products in the SNS — anthrax vaccine for example — the government is the only customer," O'Toole said. "Thus, maintaining the manufacturing capacity to ensure periodic refreshment of the SNS requires maintaining a 'warm base' — an entire manufacturing plant that exists only to supply the U.S. government's needs. This is an expensive proposition."
The United States still has the world's best scientific research base and the most powerful technological prowess, "but our technical imagination has to be matched by strategic thinking and wise choices," she said. "We have made some progress in the past six years, but our activities to date do not reflect a commitment to a national security priority. It is time to think anew about the biothreat and what we should do about it."
Seven years after the anthrax attacks jolted the nation and set off a wave of biodefense initiatives, the United States has a "highly disturbing" lack of readiness for attacks with biological agents, a leading bioterrorism expert recently told Congress.Subscribe Now for Access
You have reached your article limit for the month. We hope you found our articles both enjoyable and insightful. For information on new subscriptions, product trials, alternative billing arrangements or group and site discounts please call 800-688-2421. We look forward to having you as a long-term member of the Relias Media community.