Symposium on Public Health and Biosecurity Foreword
There’s an exceptionally interesting article in the most recent issue of the Harvard Law and Policy Review. Actually, there’s an interesting series of articles in the most recent issue. The foreword, written by Senator Tom Daschle and Tom Inglesby is what first caught my eye.
The articles are grouped into a symposia focused on improving biosecurity efforts in the US (titled Symposium on Public Health and Biosecurity). Senator Daschle and Mr. Inglesby set the stage as such:
Improving biosecurity requires long-term focus and commitment by the government and the private sector. Strengthening biosecurity is an explicit policy goal of the current Administration just as it was in the last Administration. How we approach this goal and with what speed are the critical questions.
The articles in the Symposia extend from Dr. Gostin’s vision of a global public health plan, and ultimately Fund, that could address the root causes of bio-insecurity through the broad-based improvement of global health, to the more day-to-day focus on resilience in American communities advocated by Vinter, Lieberman, and Levi. These articles are not, and should not be taken as, mutually exclusive, but instead parts to a whole.
In order for these parts to coalesce into a successful effort, the authors note that a number of things need to happen. They note that the first thing that needs to happen is that biosecurity needs to be made a priority by the Administration. This is obviously a difficult task when considering what’s going on in the Gulf, the state of the economy, the execution of military and counter-insurgency actions in the Miiddle East and Central Asia and, y’know, actually running the country. Without biosecurity being an explicit goal at the highest levels of the government, it will simply not be a priority for anyone else. And that’s important, according to the authors next two “to do’s”: developing robust prevention and response strategies.
The prevention aspect is what the Committee on the Prevention of Weapons of Mass Destruction Proliferation and Terrorism folks focused on in their seminal report, World at Risk. By continuing to support the Biological Weapons Convention, working toward improving international, national, and local disease surveillance, pursuing sensible lab security measures in our own labs and championing those measures abroad, while improving bio-forensics capacity so we are better able to attribute future biological attacks, we should be better prepared for a bio-threat.
We also need to invest in our response capability. Every recent report on the status of the public health infrastructure has shown significant eroding in our capacity to deal with everyday threats to the public health, and makes no mention of the ability to respond to something more deadly or widespread (mostly because the idea is laughable — if you can’t beat gonorrhea, how would you beat smallpox?). These response efforts are keyed off of the robust and wide-ranging biosurveillance systems that continue to elude us as a nation and world. Unnecessary duplication and a general lack of sharing of information leaves us all blind — not to mention that there aren’t enough epidemiologists to interpret the collected data. Our biosurveillance system was tested just last year during the H1N1 influenza pandemic and found lacking. Another thing that was found lacking was our hospital systems, as they became overwhelmed by a “not-worst-case” pandemic. And I’m not even going to get into the vaccine delay, or problems with actually giving it out to the public. The final piece of the puzzle has to do with the public. While the authors are optimistic that much has changed recently with regards to the resiliency of the public, and their ability to take care of themselves in a disaster, I have trouble seeing it (and truthfully, that might just be because I’m younger than just about everyone in this field). John Solomon had a great post recently about emergency mangers reluctance to give the full picture to the public; my comment there was that perhaps we should stop treating the public like children.
Like I said, a very interesting article, and one I’d recommend checking to out. I’ve also downloaded the article by Sam Berger and Jonathan D. Moreno that looks to distinguish between coercive and cooperative models of response to public health emergencies.