The Bio-Response Report Card: Some Progress,
But More Work Needed
Tara Kirk Sell, November 4, 2011
In mid-October, the Bipartisan WMD Terrorism Research Center, led by former Senators Bob Graham and Jim Talent, Colonel Randy Larsen, and Lynne Kidder, released its “Bio-Response Report Card.”1 A similar report released last year by the Commission on the Prevention of Weapons of Mass Destruction Proliferation and Terrorism, also chaired by Senators Graham and Talent, graded as “F” the nation’s ability to respond to a bio-attack.2 The newly released report card was constructed to, as the authors describe, “provide a strategic, end-to-end assessment of America’s bio-response capabilities.”(p.7)
The authors suggest that the best return on investment will result from changing “D” grades to “C” grades and focusing efforts and resources on improving grades in bio-response capabilities for large scale contagious and non-contagious events rather than small scale events. The report stresses 3 critical priorities for improvement:
Leadership that inspires confidence, commitment, and unity of effort
Mobilization of a “whole of nation” bio-response capability
Sustained investment in purpose-driven science.
An image of the complete report card is included below, accompanied by brief excerpts (italicized text) from each section of the report card itself. A full size version of the report card image below can be viewed on page 9 of the report.
Detection and Diagnosis
The United States does not yet have a nation-wide multisource disease surveillance system, as mandated by the Public Health Security and Bioterrorism Preparedness and Response Act of 2002 (BioSense). Notable improvements in disease surveillance at the state/local level are now threatened by funding shortfalls. The United States has made progress in strengthening detection and diagnostic capabilities since 2001, including environmental and population-based biosurveillance and advances in promising technologies. The larger the event, however, the higher the demand for detection and diagnosis. Large-scale events would overwhelm existing capabilities. (p. 23)
Despite extensive research, a scientifically and legally validated attribution capability does not yet exist for anthrax or virtually any other pathogen or toxin. There is not yet a networked system of national and international repositories to support microbial forensics, and existing mechanisms to facilitate collaboration among stakeholders worldwide are insufficient. However, the Centers for Disease Control and Prevention (CDC) and the Federal Bureau of Investigation (FBI) have made considerable progress in building partnerships between public health and law enforcement organizations at the federal, state, and local levels that will significantly improve cooperation during an investigation. (p. 29)
The Centers for Disease Control and Prevention (CDC) and the Department of Health and Human Services (HHS) have made good efforts to coordinate risk communication strategies with state/local partners, and have also provided pre-scripted messages for Category A biological agents and pandemic influenza. The recent development of the Biological Assessment and Threat Response (BATR) Protocol is a significant step forward in federal interagency coordination for large-scale biological events. The federal government has improved engagement of state/local agencies to address communication challenges, but has not enlisted private and non-government entities with the same effectiveness. Despite significant progress, risk communication does not always reach diverse/special needs populations. No suitable threat and risk assessment for bioterrorism is available for engaging and educating the public. (p. 33)
Medical Countermeasure Development and Production
Current stockpiles of medical countermeasures could limit the impact of small-scale attacks using anthrax and several other likely pathogens, but may not be adequate for large-scale attacks. Medical countermeasures are not currently available for resistant or novel pathogens. Adequate supplies of medical countermeasures have removed smallpox as a large-scale threat. The process for developing and producing medical countermeasures still lacks clearly defined requirements, a common set of prioritized research and development goals, coordinated budget requests, and sufficient, sustained funding. (p. 39)
Medical Countermeasure Distribution and Dispensing
The inability to dispense potentially lifesaving medical countermeasures in the event of a large-scale bio-attack presents a serious risk of needless deaths, social disorder, and loss of confidence in government. It is highly unlikely that antibiotics could be dispensed to a large population within 48 hours. The federal role in assisting local authorities to achieve this critical mission is growing, but has been slow and uneven. No local jurisdiction has demonstrated the ability to rapidly dispense medical countermeasures on a large scale under realistic conditions. Meeting the 48 hour standard will not be possible without multiple and redundant dispensing strategies. (p. 45)
Medical Management and Response
A catastrophic biological event in the United States would quickly overwhelm the capacity of an already-stressed health care system. Although there has been progress over the past decade, there is not yet a comprehensive approach to emergency medical response—from the individual citizen, through the first responder emergency medical system (EMS), to emergency departments, hospitals, and alternate sites of medical care. Although evidence suggests that a better-prepared, informed citizenry can reduce demand on hospital-based services during a crisis, currently there is minimal public investment in demand-reduction strategies. There has been incremental, but to date, insufficient progress in developing crisis standards of care. Federal medical resources and capabilities, including those residing in the Veteran’s Administration (VA), Department of Defense (DoD), and Department of Health and Human Services (HHS), have not been fully coordinated and exercised to support response to a large-scale biological disaster. (p. 49)
An integrated, tested environmental remediation plan for wide-area anthrax cleanup does not currently exist. The federal government has recently released interim guidance addressing federal, state, and local roles in environmental remediation following a wide- area anthrax attack, but the document does not address all outstanding questions—such as evacuation and long-term health issues. No remediation plans have yet been tested in a national level exercise. There is currently no consensus-based outdoor or indoor clearance policy to establish safety standards. There is no policy defining responsibility for the cleanup costs of privately owned facilities. Without the ability to clean up after an anthrax event, even an unsophisticated attack could produce an effective area-denial weapon with enormous economic consequences. (p.55)
Editor’s Note: The report card provides an honest assessment of the considerable progress that has been made in biosecurity but also the daunting challenges that remain. The authors wisely note that in the current budgetary environment it is not realistic to expect that all the challenges can be met. Focusing primarily on achieving modest gains in certain aspects of preparedness for large scale (but not drug resistant or global) events going forward, as they recommend, seems a prudent use of limited resources. Specifically they recommend prioritizing incremental improvements in detection and diagnosis; countermeasure development, approval, and dispensing; and medical management. Clinicians interested in biosecurity would be well advised to read the full report.
The WMD Center. Bio-Response Report Card. October 2011. http://www.wmdcenter.org/wp-content/uploads/2011/10/bio-response-report-card-2011.pdf. Accessed November 3, 2011.
Commission on the Prevention of Weapons of Mass Destruction Proliferation and Terrorism. Prevention of WMD Proliferation and Terrorism Report Card: An Assessment of the U.S. Government’s Progress in Protecting the United States from Weapons of Mass Destruction Proliferation and Terrorism. January 2010.