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“F” as in Failure

January 27, 2010

Some time ago, I wrote about the Commission on the Prevention of Weapons of Mass Destruction Proliferation and Terrorism, and their really great report entitled World at Risk (free copy here).  In this report, the Commission detailed 13 recommendations intended to help the nation prepare for the threat of weapons of mass destruction and terrorism.

In my earlier post, I wrote about the first two recommendations as they applied directly to bioterrorism and biological threats, and I’m going focus on them again here. Not everything published is bad news, though it seems like that’s all I ever focus on, so I encourage you to download and read the report for yourself from here.

Below is the definition of how the Commission doled out grades, for reference.

grades

First, Recommendation 1.

The United States should undertake a series of mutually reinforcing domestic measures to prevent bioterrorism:  (1)  conduct a  comprehensive  review of  the domestic program  to  secure dangerous pathogens,  (2)  develop  a  national  strategy  for  advancing  bioforensic  capabilities,  (3)  tighten  government oversight of high-containment  laboratories,  (4) promote a  culture of  security awareness  in  the  life  sciences community,  and  (5)  enhance  the  nation’s  capabilities  for  rapid  response  to  prevent  biological  attacks  from inflicting mass casualties.

I think that it’s fair to assume that point (5) in Recommendation 1 is really the goal of the recommendation – ultimately, that’s the outcome we’re looking for. And it makes sense. They’ve established that it is not only plausible, but likely, that a terrorist would successfully use a weapon of mass destruction sometime before 2013, and that weapon is more likely to be biological than nuclear in nature. In that light, rapid response should be the ultimate goal, with significant effort going to prevention efforts.

How did we do on 1.5?

The  lack  of U.S.  capability  to  rapidly  recognize,  respond,  and  recover  from  a  biological  attack  is  the most significant failure indentified in this report card.

F, as in failure.

Rapid detection and diagnosis  capabilities are  the  first  links  in  the  [preparedness] chain,  followed by: providing actionable information to federal, state, and local leaders and the general public; having adequate supplies of appropriate medical countermeasures; quickly distributing those countermeasures; treating and isolating the sick in medical facilities; protecting  the well  through  vaccines and prophylactic medications; and  in  certain  cases,  such as anthrax, environmental cleanup.  

The United States is seriously lacking in each of these vital capabilities.

F, as in failure.

The capability  to deter and  respond  to bioterrorism depends upon  the strength of all  links  in  the biodefense chain. Virtually all links are weak and require the highest priority of attention from the Administration and Congress.

F, as in failure.

(I don’t usually talk about my writing process, but I’ll admit I was stumped as to how to follow that bit up. How do you talk about something else when the THE blue ribbon panel on the subject just said that you’ve paid absolutely no attention whatsoever to what they consider to be the most pressing, and likely, threat to the United States?)

The Commission pointed out that our lack of investment in public health ultimately stung us when having to respond to what ultimately was a mild influenza pandemic:

H1N1  came  with months  of  warning.    But  even  with  time  to  prepare,  the  epidemic  peaked  before most Americans had access to vaccine. A bioattack will come with no such warning.  Response is a complex series of links in a chain of resilience necessary to protect the United States from biological attacks. Rapid detection and diagnosis capabilities are the first links, followed by providing actionable information to federal, state, and local leaders and the general public; having adequate supplies of appropriate medical countermeasures; quickly distributing  those  countermeasures;  treating  and  isolating  the  sick  in medical  facilities;  protecting  the well through vaccines and prophylactic medications; and in certain cases, such as anthrax, environmental cleanup.  We conclude that virtually all links are weak, and require the highest priority of attention from the Administration
and Congress.

Then there’s the D+ awarded for tightening oversight of laboratories (recommendation 1.3). Which we’ve talked about before. Why not an F? Because the Senate  Homeland  Security  and  Government  Reform  Committee introduced the WMD Prevention and Preparedness Act of 2009. That’s it.

The Commission does, however, issue “A” grades for implementing Recommendations 1.1 and 1.2. You know, the ones about writing reports and developing strategies? Yep, got “A’s” on them.

The Commission only issued grades on two of the four parts of Recommendation 2:

The United States should undertake a series of mutually reinforcing measures at the international  level  to  prevent  biological  weapons  proliferation  and  terrorism:  (1)  press  for  an  international conference  of  countries  with  major  biotechnology  industries  to  promote  biosecurity,  (2)  conduct  a  global assessment of biosecurity  risks,  (3) strengthen global disease surveillance networks, and  (4) propose a new action  plan  for  achieving  universal  adherence  to  and  effective  national  implementation  of  the  Biological Weapons Convention, for adoption at the next review conference in 2011.

A grade of “C” was given for action on Recommendation 2.3. Luckily, or perhaps not so luckily, we have real world evidence of the failure of the global disease surveillance networks. You might recall a little outbreak in Mexico last April? I would argue that our surveillance systems internally failed as well. There was not enough lab capacity to test sick people, so the CDC gave up on and recommended that LHDs and SHDs stop testing potential cases. If something else more sinister was co-circulating, this lack of situational awareness could’ve been devastating.

The Commission gave a “B+” to Recommendation 2.4, based primarily on the National Homeland Security Council’s release of the National Strategy for Countering Biological Threats report in December 2009. I was unaware of this document and have just downloaded it (pdf).

In sum, wow. I have the utmost respect for this Commission and have been consistently impressed with the big picture view they take of biological threats, so this report card, in my eyes, is damning. The language used is blunt and harsh. The order that the grades are presented is seemingly done to draw attention to the lack of effort by the US Government. This report card was not meant to paper over problems or focus on small miracles, but to point out that what little is being done to prepare this country for the very real possibility of a bioterror event makes no sense.

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