- The Washington Times - Thursday, February 27, 2003

President Bush's two recent efforts to ready America for the threat of biological terrorism the first to retrofit the air quality monitoring stations inside major cities in order to detect bioweapons, and then to spend $6 billion to fund new research into vaccines and antidotes as part of his BioShield initiative will both make Americans safer.
But the president's ability to rapidly deploy a series of bioweapons sensors provides evidence why the development of appropriate antidotes could take much longer.
The technology for detecting bioweapons is advanced to the point where functioning systems can be readily deployed, largely because similar tools have been used for years by the private sector. For example, agricultural companies use the same platforms found inside bioweapons sensors for the detection of contaminants in food.
Seattle-based Research International is one of about a half-dozen companies adapting machines used to detect agricultural toxins as a bioweapon sniffer. Their box, which can test air and soil samples for a range of would-be bioweapons, has already been successfully deployed on an American-made aerial drone and could eventually be used for clandestine monitoring.
Equally important, the military and civilian needs for biosensors are similar. When companies like Research International spend gobs of money adapting machines into bioweapons sniffers, they can expect to sell successful products to not only the Pentagon, but cities interested in mounting them inside public spaces like subways and sports arenas. The result? There's a big potential opportunity for successful boxes and a flurry of private innovation among companies interested in capturing a slice of that market.
All of these things aren't true when it comes to medical countermeasures and, as a result, our treatments aren't nearly as advanced as our detectors.
With treatments for bioweapons, unlike biosensors, the needs of a soldier stationed on the battlefield and an ordinary office worker are diametrically different. The key for Pentagon planners is to keep their troops on the battlefield in peak performance. That means protecting them from succumbing to a biological agent in the first place, mostly with preventative vaccines. The Pentagon can't risk troops being sick, even if it was only for a few days, say, until antibiotics or antiviral drugs took effect.
By comparison, civilians are less likely to face biological agents, and so vaccinating them for the full spectrum of bioweapons isn't practical, or even necessary. But ordinary Americans still need countermeasures.
In the face of a domestic attack, doctors might not be as concerned that civilians could fall ill to bioagents, so long as they had the tools to completely cure everyone. So, what civilians need are effective treatments that can be stocked on hospital shelves, and used to treat sick patients and mitigate the effects of an attack. The problem is that most of the research in bioweapons countermeasures has traditionally focused on the needs of the Pentagon. So, treatments have been given short shrift in favor of vaccines.
Consider anthrax, where the Pentagon is currently shopping for a better, oral vaccine in order to protect its frontline troops. It wouldn't be practical to give the same vaccine to every American, even if the final product was entirely safe, especially since anthrax isn't contagious and there's little chance it would spread outside an area of release. So long as doctors had effective antidotes stocked in centralized locations, they could easily mitigate the impact of an attack.
What would such treatments look like? With anthrax, it's not the bug itself that kills, but the deadly toxin that these bacteria release. Antibiotics like Cipro kill the bacteria and are effective only if they're administered before the infection has released too much of this poison. But, once too much toxin has been secreted, usually in a matter of days when it comes to inhalation anthrax, all the antibiotics in the world are unlikely to save a victim.
To those ends, what doctors need isn't a vaccine but an antitoxin that could mop up the deadly chemical that anthrax releases into its victim's blood. Such drugs aren't far off. There's strong scientific evidence that a group of shelved cancer compounds called metalloproteinase inhibitors, abandoned years ago because they weren't effective cancer agents, could be converted into drugs that neutralize anthrax toxin.
The same medical principles apply to a range of would-be bioweapons, from Ebola, to smallpox, to tularemia. The right antidotes can be nearly as effective as vaccines and more practical for civilians. But developing these kinds of medicines could be given short shrift unless planners adhere to a dual approach when it comes to developing countermeasures, one that considers the different needs of troops and civilians.
Since it's vaccines that the Pentagon needs most, that's where much of the government research money has often been targeted. The result could be that our cities are outfitted with the best bioweapons sensors, but doctors might not have anything to offer inhabitants if one of them should start ringing.

Dr. Scott Gottlieb is Resident Fellow at the American Enterprise Institute and a writer for the British Medical Journal.

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