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U.S. Response: Bioterrorism Response Funding Is Insufficient, Experts Say By Greg Seigle Global Security Newswire While the $3 billion biodefense authorization bill currently under scrutiny in the U.S. Senate appears poised to pass soon and distribute $1 billion across all 54 U.S. states and territories next year—dwarfing the $10 million the White House initially proposed—state and local medical communities could still experience dangerous budget shortfalls in their efforts to prepare for nightmare scenarios, analysts said. “If we spend less than $2 billion [next] year on local, state [and] city health departments, then our leaders don’t know what’s going on and don’t get it,” Tara O’Toole, director of the Johns Hopkins University Center for Civilian Biodefense Studies, said during a recent speech. “Some of that money is going to waste. There’s no help for that,” added O’Toole, who served as assistant secretary of energy for environmental safety and health during the Clinton administration. “We have got to get money to the local level very quickly in order to just get some raw capacity in there.” Roughly two-thirds of the $3 billion offered in the bipartisan bill is slated for federal coffers, much of it earmarked to develop, purchase and stockpile smallpox vaccines (see GSN, Nov. 29). A similar bill being formulated in the House is expected to make similar recommendations, according to congressional staffers (see GSN, Dec. 11). While the boosting of vaccine stockpiles is sorely needed—including vaccines for biological agents other than smallpox—a national bioterrorism response strategy should give equal weight to preparing local medical authorities, sources said. It is these people who will be on the front lines should biological weapons ever be unleashed by terrorists. The Senate bill, introduced by Senators Bill Frist (R-Tenn.) and Ted Kennedy (D-Mass.) (see GSN, Nov. 15), initially sought to provide $5 billion—a large chunk of which was aimed at providing resources to the states and local governments. But Bush administration officials have vowed to veto any bills that surpass the $686 billion budget for 2002—or the $40 billion already designated for terrorism response. “If we invested the kind of monies now that we did when [the Soviet satellite] Sputnik went up [and led to the creation of the] Apollo project, I think we would not only remove biological weapons as weapons of mass destruction threats, but I think we would also give the world great aid in dealing with malaria, [tuberculosis] and AIDS,” O’Toole said. “It’s not a matter of [states receiving] $1 billion or $2 billion, it’s a matter of slowly building up your capabilities,” said Jonathan Ban, a research associate with the Chemical and Biological Arms Control Institute. “You do need a smallpox vaccine and you do need vaccines for all the other [diseases], even though you might not use them. But you can’t do it at the expense of state and local resources because you’re definitely going to use them.” A “System of Systems” Needed “You can have all the stockpiles of vaccines you want but if you don’t have a system in place to distribute them there’s going to be hell to pay,” Ban said. “You have to have a system of systems to combat bioterrorism” at the vital local level, Ban said. “You need a system that has detection capabilities, laboratory diagnostics, epidemiological capabilities … Currently there isn’t any of that.” Ban served as the lead analyst for the U.S. Centers for Disease Control and Prevention report “Bioterrorism in the United States,” released in July after a 15-month study that examined the response capabilities of seven large cities, including New York, which is considered the leader in civilian biological defense preparedness. In the last couple years New York has established an evolving monitoring system that enables local authorities to track and categorize hospital admissions, 911 calls, water supplies and even absenteeism rates with large employers. If authorities notice a spike in one or more of the categories they might be able to head off a biological outbreak before it spreads too fast, sources said. Quick Response is Key “If you don’t detect [a biological attack] early it’s going to be a big problem, the way people move around [the world] today,” Ban said. “The better you respond, the better you can handle the situation and mitigate the consequences.” Currently the CDC advocates a “ring containment” strategy (see GSN, Nov. 27) modeled after the World Health Organization method that successfully eradicated smallpox from the world by 1980. If one person is exposed to a contagious, potentially lethal biological agent, local authorities need to quarantine them quickly and at least the last 20 people who had been in contact with them. Sources said the crucial factor in such worrisome scenarios is rapidly identifying the outbreak, so it can be contained. Hence, doctors, emergency crews and other local officials on the front lines need to have as much funding as training as possible, they said. “I think it’s pretty apparent to people by now, following the anthrax attacks, that medicine and public health is at the heart of a response to bioweapons threats,” said O’Toole. Public Health Vulnerabilities “There are a lot of vulnerabilities” at the local level, she said. “First of all, [doctors] haven’t seen anthrax. They haven’t seen smallpox. They don’t know what to look for. They don’t know how to diagnose it. The big problem we saw [was] with the two patients, one in D.C. and one in Maryland who went to their doctor’s offices, went to the emergency room and were sent home with anthrax and later tragically died.” In addition, there is no surge capability in the medical system, sources said. Hospitals keep just enough supplies and workforce on hand for daily needs—and they are pitted against each other as competitors and not prepared to work together, sources added. “In the search for [financial] efficiency we have eliminated all excess capability,” said O’Toole. “The public health system is even worse shape … We have not invested sufficiently in this system … The local health departments are bereft of resources. Half of them do not have Internet connections.” “Connectivity is a major problem,” Ban added. “Hospitals are unprepared, doctors are unaware … Many of the locales don’t even have distribution systems.” In the event of a biological attack, CDC plans call for federal authorities to fly in vaccines and other emergency supplies and drop off them at a prearranged airport hangar, sources said. Then it is up to local officials to distribute these crucial supplies. One big-city fire chief interviewed by Ban for the CDC study said he planned to take the vaccines and other supplies to fire stations, then go on local television to inform the public to come get their shots. “Can you imagine the psychological effect, the mad runs on the fire house?” Ban asked. “And would the fire chief himself be the one administering antibiotics?”
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