Pyres: 2001 UK FMD Outbreak - Photo: Murdo Macleod.  Slides L-R: Smallpox, SARS Coronavirus , Foot and Mouth Disease, West Nile Virus.
20 November 2011

Feedback: Biodefense - We Are Still Not Ready

In deepest appreciation for the feedback from the discussion "Biodefense - We Are Still Not Ready."  I would like to share the following response from the LinkedIn Network for Public Health Law, by Craig Vanderwagen, former Assistant Secretary at U.S. Department of Health and Human Services, Assistant Secretary for Preparedness and Response at Department of Health and Human Services (20062009):

I am most pleased to see you continue to underscore the reality of the threat picture that we have in global health generally and in the potential for man made events domestically. I believe that Hylton may have done some disservice to the issue by reducing it to a personality drama among federal officials with responsibilities in the area. The only clear point that emerged (other than that the profiled individuals are petulant, arrogant, competitive, and/or generally appear immature in his characterization) was the sense that the WH needs to appoint a czar for the issue. The fact is that PAHPA has designated a lead role for ASPR and it is up to HHS to give that role full expression. But the more important concern is the one that you raised but does not appear in Hylton's article: the rapid decline in public health capacity in the state and local arena where the functional impact of preparedness and public health exist.

I wholeheartedly agree that the best solutions in public health are locally embraced and implemented. The federal role should be to build that capacity, or provide the tools that economies of scale dictate should be developed at a more central level. The medical countermeasure enterprise is an example of an appropriate use of central assets to develop tools for local use, that would otherwise be out of reach of local development. But as you rightly point out, the delivery of these interventions is a local phenomenon that requires a strong and capable local public health infrastructure. Unfortunately that is being rapidly dismantled at the state and local level as you note.

The basic resiliency of the Nation is being undermined by this approach to cost saving. It does this not only by eliminating needed trained personnel to prepare for and respond to events, but it is undercutting the basic public health initiatives that address the underlying health of Americans such as immunization programs, Maternal and Child Health programs, disease prevention targeting heart disease, cancer. etc. This will inevitably create a less well population with the physical and mental reserves needed to not only survive disaster events, but to recover to full functionality.

But this is not a new reality, it is but a more intense version of the routine challenges made to public health activities. I can recall being asked by OMB (in the 1990's) to justify why building water and sewer systems in Indian Country was important to health, almost a century after the health impacts of this approach to basic public health had been demonstrated to significantly affect mortality (especially in children) and morbidity (in adults infected by water borne disease).

The threat to CDC is real, but it is more significant that the state and local elements are being decimated. This is a reflection of local political decision making about program priorities (are police more important than a public health nurse? on a Maslov scale probably yes) and falling revenues (no new taxes). CDC is important in that its most effective role is in its support to state and local programs through its grant programs. Those programs should be given great preference in protection from reductions. The internal bureaucracy in Atlanta is of lesser importance (altho still important) if we are to have "on the ground" capabilities that are strong and resilient.

But then most readers of your blog would agree that the reality that is unfolding is dire. But unless the mainstream media takes a substantive view (rather than the TMZ personality focused approach) view of the issue, it will continue to decline until we have a crisis event that provides a story "with legs" that will influence the population's (and the political element in particular) understanding of the threats that are unfolding and that we have denied in order to meet budget reduction goals through prioritization.

Looking forward to feedback and progress on this public health infrastructure dicussion, that was a priority focus during contingency planning for Y2K.  At that time, we had the Center for Civilian Biodefense Studies, and today, the Center for Biosecurity, still under the leadership of D.A. Henderson.


16 November 2011

From: Stephen M. Apatow
Founder, Director of Research & Development
Humanitarian Resource Institute
Humanitarian University Consortium Graduate Studies
Center for Medicine, Veterinary Medicine & Law
Phone: 203-668-0282

Pathobiologics International

Biodefense - We Are Still Not Ready

The New York Times on 26 October 2011 ran the article:
How Ready Are We for Bioterrorism? 

In response, LOWELL P. WEICKER, former U.S. senator and governor of Connecticut wrote:

Wil Hylton’s article “How Ready Are We for Bioterrorism?” raised important concerns about how hard it is to protect the country from naturally occurring and man-made biological threats. He outlined how the lack of profitability and the bureaucratic hoops required to get vaccines and medical countermeasures to market can mean we’re often our own worst enemy. But he missed an equally important and extremely troubling part of the equation: cuts to the Centers for Disease Control and Prevention and to state budgets mean that even when we have medicines and vaccines, we aren’t in a position to get them to Americans quickly. Federal support for preparedness has been gutted, dropping 37 percent since fiscal year 2005, and state and local health departments have cut an estimated 44,000 workers between 2008 and 2010. After Sept. 11 and anthrax, we built up biodefense capabilities, but we’re moving backward. When the next tragedy strikes, we will not be ready. The price tag for lack of preparedness will be American lives.

This topic brings me back to the discussion "Preventing a WMD September 11" (Humanitarian Resource Institute Biodefense Legal Resource Center, February 2004):

Today, the threat of smallpox as a weapon of mass destruction  threatens a significant percentage of the global population. In the United States, approximately 25 percent (70 million) of the population would be excluded from smallpox vaccination due to risk factors that include eczema, immunodeficiency, or pregnancy, in themselves or in their close contacts. Extended to the global population base, approximately 1.5 billion would be at serious risk if smallpox spread worldwide due to a bioterrorist incident, in a scenario exponentially complicated since vaccination is the key variable for containment and control.

As discussed during the Future of Biodetection Systems Workshop, [1] sponsored by Los Alamos in 2006, it is critical that we advance a collaborative One Health global response to these unmet needs.  [2, 3]

Looking forward to your feedback.

Related HRI:UNArts One Health News:


1. The Future of Biodetection Systems - Final Workshop Analysis: The Future of Biodetection Systems Workshop was held last year to bring together industry, academia, national labs, and federal agency personnel in an interactive process, to develop a roadmap for research and development investment in biodetection.  Sponsored by Los Alamos National Laboratory, September 26 & 27 2006. -- Overview: BTACC Pathobiologics International.  Keynote: DNA-based Detection Technologies (Powerpoint): Stephen M.Apatow, Humanitarian University Consortium Graduate Studies Center for Medicine, Veterinary
2. H-II: Stephen Michael Apatow Named Ambassador for Vet2011: 250th Anniversary of the Global Veterinary Profession: Humanitarian Resource Institute, 7 February 2011.
3. HRI:UNArts: Global Comprehensive Health Organization, One Health Commission Locates to ISU: Humanitarian Resource Institute, 3 March 2011.  Includes Yale School of Medicine: Yale Human Animal Health Project – A Center for “One Health” studies (USA)

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