Technology Only a Small Part of Detecting Bioterrorist Threats
But experts say the threat is two-fold. Naturally occurring infectious diseases can spread quickly in urban centers. A terrorist attack using known bio-weapons such as anthrax is a possibility as well.
The aftermath of 9/11, and the anthrax attacks later that year, have pushed the field of “biosurveillance” to the forefront.
Biosurveillance is defined as gathering, analyzing and interpreting data to monitor for pathogens in plants, animals, humans, food and the environment.
But technology such as the BioWatch monitors that dot U.S. urban landscapes are only a small part of the equation, public health officials said at a recent conference.
“Imagine if you were to go to a physician for an ailment and the only thing the physician could do is listen to your lungs, and that was it,” said Pamela Diaz, the Centers for Disease Control and Prevention director for biosurveillance coordination. “There may be any number of other things wrong or going on that would be indicators of a problem with your health, but if that physician only looked at that one point, it would be, perhaps, not in your best interest,” she said at the 2011 Biosecurity Conference in Washington, D.C.
Biosurveillance is a broad domain that requires a skilled work force that must include global, federal, state and local partners, she said. It’s complex and requires collaboration between organizations. It’s not a matter of creating one, single information technology solution, she said.
Acquiring new technology should not be the top priority for biothreat detection, several speakers noted. Instead, it should be building human-to-human partnerships for information gathering and the improvement of existing networks necessary for early detection and warning.
Randall Larsen, CEO of the WMD Center, a bipartisan, not-for-profit research and education organization, compared the fight against naturally and man-made pathogens to a traditional war.
“If somebody is attacking America with biological weapons, particularly a contagious pathogen, then America has become a battlefield. And on the battlefield the leaders must have situational awareness. You need to know what’s going on,” Larsen said.
The anthrax attacks in 2001 — codenamed “Amerithrax” by the FBI — killed five and sickened 17 others when letters laced with spores were sent through the mail. It was the worst biological attack in U.S. history, according to the FBI. The most likely biothreat comes from nature, but the most significant threat is from a bioterrorism attack, Larsen said.
With bioterrorism “you’re dealing with a thinking enemy. Mother Nature can be very harsh, but a thinking enemy takes into consideration what your response will be and then does things that confound your response,” Larsen told National Defense.
When leaders fund and develop counterterrorism strategies, the image of a burning mushroom cloud often dominates decision making, but Larsen said bioterrorism is a more likely scenario. Nuclear terrorism requires access to highly enriched uranium or plutonium, neither of which exists in nature. Pathogens, such as anthrax, however, are readily available or can be grown in a lab.
Larsen said a biotechnical revolution has evolved during the last five decades, but it has grown rapidly in the last 10 years. It has also given ordinary civilians all over the world access to biotechnology that would have only been available to superpowers in the past. Weaponizing pathogens, by methods such as aerosolization, is also now possible with commercial, off-the-shelf supplies, he said.
Emerging infectious diseases are another major threat biosurveillance professionals are tasked with monitoring. These diseases can be categorized as: newly identified pathogens such as AIDS or SARS; existing organisms such as influenza that change or evolve; a known infection that spreads to a new area; or recognized infections that reemerge because of drug resistance.
Ren Salerno, a senior manager at Sandia National Laboratories, said at least one newly identified infectious disease is reported every year. There are almost 40 diseases that were unknown a generation ago, according to the World Health Organization.
In October 2007, the White House released Homeland Security Presidential Directive 21 (HSPD-21), which mandated a national biosurveillance capability for human health to be coupled with a connection to international disease surveillance systems. Responsibilities outlined in HSPD-21 include the management of health-related data and information for early warnings of threats and hazards, whether their origin is intentional or unintentional.
HSPD-21 charged the Department of Health and Human Services with establishing the nation’s biosurveillance capability. The Centers for Disease Control and Prevention, an HHS agency, was subsequently put in the lead role.
Diaz said it is still difficult to acquire the right kinds of data necessary for biosurveillance. It requires looking at multiple indicators across multiple systems to monitor a population. Some of that data come from the healthcare facilities such as hospitals. There is an inherent problem with gathering data from a nationwide, decentralized system. “That public-private partnership is important … so a top-down approach doesn’t always work so well,” she said.
As the agency pushes forward with the national biosurveillance strategy, it has several areas where it needs to improve its performance, Diaz said. They include: laboratory information sharing; investigating and researching the use of unstructured data such as information from the Internet and social networks; the integration of biosurveillance information where it’s important and reasonable to integrate; and developing global disease detection.
The CDC is also attempting to get a handle on the myriad programs for disease detection across the federal government. It is compiling an intra-agency registry of biosurveillance activities. It identified 285 such programs within the CDC alone. The goal is to connect experts and build interoperability.
Alexander Garza, assistant secretary for health affairs at the Department of Homeland Security, refuted the notion that the air monitors located in 30 cities were just a collection of air quality filters to detect a mass pathogen release. The BioWatch program, employed by DHS in conjunction with Environmental Protection Agency, is “a program that has been developed to build capacity around the technology,” he said.
DHS has developed other technologies that provide biosurveillance workers with situational awareness, a key component that Larsen said is often missing from strategies designed to respond to a biothreat.
DHS’ national biosurveillance integration center’s biological common operating picture is a manually updated Google Map application that tracks biological events worldwide. The biosurveillance common operating network supports the department’s Google Map system and also monitors, tracks and disseminates relevant information through a system called Global Argus. It relies heavily on public information sources such as newspapers.
A 2010 GAO report said this information gathering system searches and filters more than 13,000 overseas media sources in more than 34 languages.
Reducing the nation’s vulnerability to biological attack is the department’s goal. This is accomplished by building better healthcare systems and infrastructure, Garza said. Locally, DHS creates resilience in communities through its grant programs. But what communities need, Garza said, is a strategic communication strategy to analyze and report relevant information.
“The isolated surveillance systems that we use today are rather simple, and I’d hesitate to even call them systems. What we truly have is a system of systems,” he said.
At the biosecurity conference, speakers from the private sector also emphasized the importance of building international partnerships rather than developing new technology.
“I think the technology is actually a little bit ahead of where our capabilities are, which is normally the other way around. But I don’t think we’re necessarily taking advantage of technology the way we can and should,” said Evan Skowronski, senior scientist at the Tahoe Research Initiative, which specializes in working with developing countries to detect and identify diseases.
Overseas engagement is a policy Skowronski strongly recommended for the U.S. government. He said it’s critical for public health workers to build a working relationship with other countries.
“You’ve got to go there; you’ve got to visit the institutions; you have to spend time there,” he said. Sustainability — not just funding — must also be considered. The U.S. government must consider what it can actually do overseas based on local infrastructure. That way “it doesn’t fall apart as soon as you turn your back,” he said. An expensive machine does not do any good in a country that can’t afford to maintain it.
Rebecca Katz, a professor at George Washington University’s department of health policy, said human behaviors such as globalization, urbanization and a growing demand for animal protein have contributed to events like the SARS epidemic that cost East and Southeast Asia an estimated $30 billion to $60 billion in lost trade and tourism and indirect costs.
SARS infected more than 8,000 people in 2003. More than 700 died. It first appeared in Southern China in November 2002 and was recognized as a global threat in March 2003.
Katz said 84 percent of the world’s countries, representing 85 percent of the world’s population, have only “low-level capacity for event-based surveillance.” Event-based surveillance is the ability to rapidly detect, report and assess public health events such as an unexpected cluster of diseases.
Larsen said the United States helping to develop international biosurveillance networks would be “a good return on investment.”