“F” as in Failure
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.
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
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.