- The Washington Times - Tuesday, July 8, 2003

An enlightened approach to the problem of bioterrorism could, within a generation,eliminate bioweapons as agents of mass lethality. Thus far, the government has taken a number of useful incremental steps intended to improve the country’s ability to withstand a bioterrorist attack, but the Bush administration and Congress are treating bioterrorism as though it is a public health problem with national security implications — not as a strategic threat to the nation. This is a mistake.

A single terrorist attack on America, no matter how catastrophic or tragic, is not likely to threaten the continuation of fundamental social institutions or democratic processes — unless the attackers wield a nuclear or biological weapon. Only these weapon classes have the capacity to inflict casualties on a scale that could threaten the viability of a city’s or a region’s key institutions. A covert bioterrorist attack would likely also impose a widespread sense of vulnerability, as officials tried to determine who else was at risk from the original attack, and people across the country worried that more attacks were on the way.

In the fall of 2001, 22 cases of anthrax shut down delivery of the U.S. mail to Congress for six weeks and landed 10,000 people on antibiotics. Outbreaks of contagious disease, which can be spread from person to person are especially disruptive. A few dozen SARS patients in a major teaching hospital in Toronto forced the closure of the Intensive Care Unit, the Cardiac ICU and the SARS assessment unit, and diversion of ambulances to other hospitals. The Far Eastern Economic Review estimated that, as of April 2003, Asian economies had suffered losses of $10.6 billion as a result of SARS.

Bioweapons are attractive to would-be terrorists, in part because the materials needed to make them are openly available, and usually indistinguishable from equipment intended for legitimate purposes. The basic expertise required to build a potent bioweapon is possessed by many tens of thousands of individuals throughout the world, and the procedures associated with growing large quantities of pathogens are practiced routinely for many beneficent and profitable purposes and openly available. As we have seen in the wake of the 2001, anthrax attacks, assigning responsibility for a bioterrorist attack is extremely difficult — a feature that both enhances terrorists’ attraction to these weapons and diminishes traditional deterrence through retribution.

The effectiveness of 20th-century bioweapons — those bacteria and viruses that are on the Centers for Disease Control and Prevention list of Class A Agents — have been known for decades. What the world will soon have to contend with is the dark side of the stupendous advances now occurring in bioscience.

We are in the early stages of a revolution in the life sciences that is revealing and allowing us to manipulate the “parts list” and “biocircuits” of living organisms. These new powers to play Lego with living organisms will produce prodigious benefits in medicine and agriculture. But this same knowledge will also, inexorably, allow the creation of new and more dangerous pathogens, new ways of “weaponizing” such pathogens and novel means of inflicting them on civilian populations.

There is no way to decouple beneficent and malignant applications of this knowledge: Understanding the mechanisms of disease can be used to cure the dreaded illness or to worsen the affliction. Furthermore, as with any advancing field, progress will make the key technologies needed to carry out such manipulations simpler and more available.

What should the country be doing about the threat of bioterrorism?

• For starters, bioweapons and nuclear weapons should be distinguished from all the other countless ways a thinking enemy could attack American civilians. Countering bioterrorist attacks should be a top-level goal of U.S. national security strategy, on par with avoiding nuclear war or preventing new countries or terrorist groups from acquiring nuclear weapons.

• Second, the United States should leverage its extraordinary bioscientific talent and resources against the bioweapons threat. We need to enlist the country’s best research scientists, clinicians and public health professionals from universities and the private sector in the creation of a major research and development program, the aim of which should be to eliminate epidemics of infectious disease in our lifetime.

The core of such a program should be a research and development effort that aims, in the near term, to produce diagnostic technologies, drug therapies and vaccines against the 20th century bioweapons threats — anthrax, smallpox, etc. Commendably, following the attacks of 2001, the administration moved rapidly to establish a large reserve of smallpox vaccine. But there is a need to fundamentally change the way we currently pursue biomedical research and product development. We must find ways to dramatically reduce the time from the discovery of a new pathogen to the production of effective therapy. It now takes about 8 to 10 years to develop and license a new drug or vaccine. If we are to contend successfully with the bioterrorist threat in the age of modern biology, we must shrink the time from “bug to drug” to weeks.

The biodefense research and development effort, being run by the National Institutes of Health, is a step in the right direction, but the scale is much too modest, and there is no long term plan — not even an articulated commitment on the part of the government to affirm that such research is considered vital to national security and part of a larger defense strategy. Unless political and scientific leaders affirm the importance of biodefense, top scientists are not likely to abandon their current projects for biodefense research and development, nor are young scientists likely to enter the field. Ways must be found to link the expertise that resides in the private sector biotech and pharmaceutical communities to the nation’s need to produce effective bioweapons countermeasures cheaply and quickly.

NIH is the world’s greatest institution of biomedical research, but it is not in the business of producing drugs and vaccines, and many doubt that the traditional NIH peer review process can deliver useful countermeasures anytime soon, if at all. Whether the administration’s Bioshield initiative will entice private sector investors into biodefense research and development remains to be seen, but most observers judge it highly unlikely that such modest tweaking of market forces will produce a robust biodefense program.

• Third, therapies and vaccines are, of course, useless unless we have medical and public health systems that are capable of delivering medicines to where they are needed and caring for sick people — possibly very large numbers of very sick people needing care suddenly and for extended periods.

One way or another, we will have to build the medical systems necessary to cope with sudden mass casualty situations and the public health systems needed to provide the situational awareness essential to managing epidemics, whether they be natural or deliberate. Designing and implementing such systems will not be easy, fast or cheap.

• The cost of not having them in place, should they be needed, could be catastrophic loss of life, economic instability and permanent damage to democratic processes.

Funding for biodefense must be commensurate with the seriousness of the threat and the magnitude of action needed. In the wake of the terrorist attacks of 2001, the Bush Administration requested, and Congress appropriated, over a billion dollars to improve the ability of state health departments to respond to possible bioterrorist attacks — a tsunami of money in public health, an area of civic investment that has been neglected for generations. Yet, according to the American Public Health Association, this infusion of cash has not even offset the loss of resources most state health departments are experiencing as a result of state budget downturns. In this fiscal year, only $535 million is being sought to improve mass casualty preparedness among the country’s 5,000 hospitals. The $1.72 billion appropriated for research and development related to biodefense and emerging infectious diseases is the largest single increase in NIH history. But compare these figures to the $6.8 billon being spent on missile defense research and development in fiscal year 2003 alone.

This proposed biodefense strategy is a radical departure from current thinking about national defense priorities. The political and economic costs of a serious biodefense research and development effort, of significantly improving medical and public health bioterrorism response capabilities, are large.

The political, economic and human costs of not building these programs, of not improving vital systems until after a major bioterrorist attack, will be larger. If America were to take on this challenge, if we decide to amass our scientific talent against the mysteries of infectious disease, and we figure out how to build health systems that actually work, on a large scale and in crisis, we could, within a generation, rid the planet of the ancient scourge of infectious disease epidemics.

Drs. Tara O’Toole and Thomas Inglesby are director and deputy director, respectively, of the Johns Hopkins University Center for Civilian Biodefense Strategies.

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