America’s response to potential worldwide biological threats — either naturally occurring or imposed by terrorists — must evolve, experts told the Blue Ribbon Study Panel on Biodefense during its April 25 public meeting addressing current transnational biothreats and the global security efforts to combat them.
“Biological threats to our nation increase continuously and recognize no borders,” said former U.S. Sen. Joe Lieberman, co-chairman of the panel. “America needs to better prepare, and we need to ensure other countries are also prepared.”
“The time is over,” added panel co-chairman and former Gov. Tom Ridge, “for assuming nation-states and terrorist organizations are not involved in developing biological weapons programs.”
Several public health experts provided the panel with their recommendations on several related topics, including homeland defense and security, global security responses, and elevating international health security as both a national and global priority.
Dr. Howard Zucker, New York State Commissioner of Health, provided recommendations on managing transnational biothreats from the viewpoint of managing infectious disease outbreaks in New York City.
“In public health, the question becomes whose job is it to address these threats?” Zucker said. “The truth is … it’s everyone’s business.”
Including, he said, the U.S. Department of Health and Human Services (HHS), the White House, the U.S. Department of Defense (DOD), the Centers for Disease Control and Prevention (CDC), the Federal Emergency Management Agency (FEMA), the U.S. Department of Homeland Security (DHS), local and county health departments, and the nation’s state departments.
“From there we move to the entire global health community,” said Zucker, citing the World Health Organization (WHO) and United Nations (UN) as among relevant stakeholders. “We need an all-hands-on-deck approach.”
Zucker recommended three vital tasks necessary for managing an infectious disease outbreak: clinical management, consequence management and communications management. And across all three tasks, there must be defined collaboration and vigilance, he added.
One expert speaking during a panel on global security agreed. Former senior political advisor Dr. James Lawler, a retired U.S. Navy commander and director of international programs and innovation at the University of Nebraska’s Global Center for Health Security, provided perspective on how the U.S. government places domestic biodefense in the global context.
“The elephant in the room,” Lawler said, “is that the United States is woefully unprepared for transnational biothreats.”
Lawler outlined three problems: America’s lack of threat awareness, poor situational awareness and its reactive approach. The intelligence community has yet to figure out how to deal with biothreats, he said, but what’s more concerning is a lack of situational awareness in day-to-day threats here and abroad.
Biology moves quickly, added Lawler, noting that influenza has a doubling time of two days. “And these current events are happening even before we can get our pants on,” he said.
The United States also has a pervasive tendency to look at problems in reverse, he said, particularly regarding rapidly emerging biothreats.
“The static list of threats hasn’t changed in 30 years. We have based assessments on this list of threats and we’ve assumed that our adversaries haven’t picked up a scientific journal since 1930. We are not at a level where we’re dealing with the threats of the future and we need to move to that level,” Lawler said.
Lawler’s solutions included simplifying how the U.S. government deals with transnational biothreats via innovative countermeasures, including new solutions and technologies like pathogen agnostic indicators and artificial intelligence. “Innovation is key to moving us ahead in preparedness,” he said.
“We need to think beyond the linear approach we’re using now. We’re not going to be able to scale our way out of this problem by doing bigger and better,” Lawler concluded. “The best time for action was probably 10 years ago, but now is as good as we’ll get.”
Business plan also needed
The most-pressing transnational biothreats are influenza and antimicrobial resistance — meaning germs that don’t die from antibiotics, said distinguished professor Michael Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota, during the Study Panel’s luncheon keynote address.
And in a more-interconnected world economy supported by accelerated global trade, travel and translocation, he said threat response takes on new meaning. Nation leaders, as well as WHO and the UN, have predicted that the world’s high risk of major health crises is widely underestimated and preparedness and capacity to respond are critically insufficient.
In fact, according to a Jan. 8 opinion piece Osterholm co-wrote for The New York Times, this past winter’s flu epidemic “won’t compare with the flu pandemic that is almost certainly on the horizon if we don’t dedicate energy and resources to a universal vaccine.”
“It’s a whole different world today. We can’t deliver public health like we did 20, 30, 40 years ago,” said Osterholm, author of “Deadliest Enemy: Our War Against Killer Germs,” during the Study Panel event. “Public health is a never-ending investment need.”
Without ongoing federal and international appropriations, problems can resurface, he said, pointing to Venezuela’s recent and ongoing outbreak of malaria, which had been eradicated, but now has resurfaced in urban areas of the South American country.
“It’s a stark reminder about what we need to do to improve but also what we need to do in order not to lose ground,” Osterholm said. “The risk doesn’t go away and it’s only getting more complicated. We’re not sure what could hit next; it could be influenza on steroids. We can tell you with certainty that these [events] will continue to happen.”
Therefore, it’s time, Osterholm said, to take a step back and think about devising a coordinated, fully funded response. “Why? Because we could have another 1918,” he said, referring to the Spanish flu outbreak, one of the world’s deadliest pandemics that infected some 500 million people globally, killing an estimated 20 million to 50 million people worldwide.
“I’ll give you a minute to let your head wrap around that and what it would mean today,” he told the audience and panel members. “A pandemic would be the least of our problems; it would be all the collateral damage we’d have to deal with and we’re doing nothing, we’re doing nothing.”
A business model that prepares the United States in a “global just-in-time economy world” would help, Osterholm suggested. For instance, technology exists to develop a vaccine that could be given once every 20 years or more to fight multiple virus strains, but inadequate commitment exists to develop a business model and plan to make it a reality.
Similarly, he said, virtually all generic drugs are made in China. With roughly 14 million Americans taking insulin every day, for example, and the CDC reporting in 2017 that upwards of 100 million Americans are diabetic or prediabetic, where would they get their medications if there’s a shortage, Osterholm asked. “See how vulnerable we are?”