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Expert Sees Similar Challenges in Responses to Pandemic Influenza and Bioterror Attack By David Francis WASHINGTON — Parallels between U.S. bioterrorism response plans and the National Strategy for Pandemic Influenza released last week highlight challenges posed by disease outbreaks that occur naturally or through intentional acts, a bioterrorism expert said (see GSN, Nov. 2). “I think there are overlaps between planning and response to pandemic influenza and an intentional bioterrorism attack,” said Richard Waldhorn, a Georgetown University professor and a distinguished scholar at the University of Pittsburgh’s Center for Biosecurity. The National Response Plan outlines how the United States should respond to a biological attack, setting up coordination between federal agencies and providing guidance to state and local law enforcement and public health agencies. The plan outlines: how a biological incident would be detected; how its source would be determined; how public health and law enforcement response would be shaped; how to control the outbreak from becoming epidemic; and how to supplement public health and medical services. The pandemic influenza strategy has been undergoing revisions since the 1970s. Recent fears over an avian flu outbreak prompted the government to finish the strategy. Like the National Response Plan, the flu strategy: outlines how to detect a pandemic outbreak and track people who could be or are infected; discusses how countermeasures should be used and how to manage shortages of drugs; and suggests how to manage hospitals and public health services during an outbreak. Quarantines for sick patients are also an option. In most cases, the plan does not offer specifics on what to do, but suggests courses of action to local and state authorities. Waldhorn said the first difficulty in a bioterrorism attack or an outbreak of pandemic flu is isolating the origin of the disease. Knowing where the disease began makes it easier to track people who could become sick. “We don’t know exactly … who it’s going to attack, where it’s going to occur,” he said. That would be the case whether trying to locate the origin point of a flu outbreak or an anthrax attack, Waldhorn said. “Achieving that sort of situational awareness is a challenge.” Another challenge is the ability of the U.S. government and the pharmaceutical industry to produce vaccines. The Bush administration announced that it would dedicate $1.7 billion toward the development of an avian flu vaccine. Congress has been working through the Project Bioshield legislation to boost the pharmaceutical industry’s development of bioterrorism countermeasures, with limited results so far due to companies’ concerns over liability and an uncertain market for the products. “The ability to ramp up vaccine production,” Waldhorn said, “would be a conveyable challenge with a large-scale biological attack” as well as with pandemic flu. “Some of the same issues on how to get a national security approach towards bioterrorism countermeasures” come up when discussing flu vaccine development, including promoting development by drug companies and boosting overall production. Also problematic in both scenarios is how the public health infrastructure would handle a surge of highly contagious patients following an attack or outbreak. Many hospital workers lack the training to deal with these types of situations, including doctors who recent studies have found have difficulty recognizing the symptoms of biological agent infection (see GSN, Nov. 3). Waldhorn said the best way to fill gaps in the response plans is to create strategies that could fix shortcomings in both, such as creating a production infrastructure that could be used to make vaccines to counter the flu and biological threats. “Those of us who have been interested in biothreats believe if we make investments in bioterror, it should be dual use,” he said.
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