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Improving the Recommendations of the Blue Ribbon Biodefense Report

The tragic saga of the death of Thomas Eric Duncan from Ebola Virus Disease (EVD) serves as a perfect demonstration of the shambolic state of biodefense in the United States in late 2014. Duncan, infected in Liberia, was initially turned away from the ER of Texas Health Presbyterian Hospital in Dallas, despite having an extremely high fever, and, crucially, having fully disclosed his travel history. Returning to the ER of the same hospital three days later, Duncan was finally tested for EVD; he died on October 8, 2014. It took five days following his diagnosis for the apartment he was staying in to be decontaminated by “The Cleaning Guys,” a private local contractor team based in Dallas. It is not unreasonable to ask how such a catalog of errors could have occurred in a nation that spent close to $80 billion on biodefense between 2001 and 2014.

With this recent history in mind, a handful of former executive branch and congressional leaders convened the Blue Ribbon Study Panel on Biodefense to look into “the insufficiency of [the US’s] myriad and fragmented biodefense activities.” Since the issuance of their report in October 2015, the panel members have participated in a number of hearings on the issue in both the House and Senate, including two hearings on the topic this month alone (here and here). The group’s very welcome recommendations go some way towards addressing the flaws in US biodefense strategy that Duncan’s case illuminates, but they still leave gaps (several of which are discussed below) that could be exploited by nefarious actors and naturally occurring pathogens alike.

Centralized control. The report’s call for a centralized command and control structure for national biodefense is, arguably, the single most important step the US could take to improve its biodefense capacity. The glaring lack of such a command structure was illustrated during the recent EVD outbreak, when it was obvious that different states had different protocols for dealing with both EVD patients and the institution of mandatory quarantines, which, in turn, were different from those recommended by the federal government. The spat over the quarantine of Kaci Hickox between the governors of New Jersey and New York, New York City’s mayor, and the White House could not serve as a clearer example of why national coordination on biodefense needs to be established, and soon.

The uniqueness of biological threats. While the recent EVD outbreak was, of course, naturally occurring, and (despite reports to the contrary) EVD would not make for an effective biological weapon, the report explicitly recognizes that all biological threats — biological warfare, bioterrorism, biocrimes, pandemic illness, and accidental release — should be subsumed into a single national biodefense strategy. This is a crucial step for the US to implement. Not only would it foster much needed cooperation and standardization of procedure between all actors and agencies involved — from the Intelligence Community to the US Public Health Service to healthcare professionals in general — but it serves as an explicit statement of an obvious truth: Regardless of whether an outbreak of an infectious agent is naturally occurring or the result of a biological attack, the effects and medical response to any infectious disease event in the US would be more or less identical.

Having said that, the report’s recommendation that biological weapons should be recognized as a discrete intelligence topic within the IC is equally important. Too often, biological weapons are considered — from an intelligence point of view — as similar to chemical or radiological weapons. They wind up being lumped into a catch-all unconventional weapons category, or, worse, are treated as weapons of mass destruction. This is a mistake, and it is important that the authors of the report have recognized it as such. Biological weapons are unique, principally because these weapons have the potential to cause epidemics. They are, as the title of Gregory Koblentz’s outstanding book on the subject makes clear, living weapons. As such, they require specific scientific and intelligence expertise to analyze.

The role of biosurveillance. The report, rightfully so, emphasizes the importance of biosurveillance to effective biodefense. However, while the importance of reliable automated biodetectors should not be understated, it is crucial to also remember that the most important element of biosurveillance is the human element: If a biological event were to occur, the front line of detection would be in ERs, urgent care centers, and family doctors’ offices.

This is why it is vital that all healthcare professionals should be aware of the signs and symptoms of potential biological threat agents and a robust mechanism be in place for reporting any suspicions of their incidence. In addition, healthcare professionals must be alert to unusual or unexpected patterns of illness — this may indicate the beginnings of an outbreak or an attack. A good start would be ensuring that all healthcare professionals are aware of the signs and symptoms of those pathogens listed as select agents.

Changes to the Select Agent Program. The report’s recommendation to review the Select Agent Program (SAP) — a list of biological agents and toxins that potentially pose a severe threat to public health and safety maintained by the Department of Health and Human Services — is not without risk. The rationale for making the list of select agents more dynamic is sound. Currently, the list is static, with strict criteria for a pathogen to be designated a select agent. The report recommends that the list be made more dynamic, and that it be more concerned with the characteristics of pathogens, rather than the current simple binary of whether a named pathogen is on the list or off. This change reflects the increasing problem of potentially harmful agents not being on the current list, as well as the changing nature of the life sciences, in which novel or altered harmful pathogens could be engineered yet not be considered select agents.

However, the notion that removing obstacles for laboratories to engage in biodefense-related research using some of the deadliest pathogens known to man (including anthrax, Marburg virus, and EVD) is a double-edged sword. While more biodefense research and development may well be conducted under such a revision, a possible proliferation of laboratories engaging in that research would also lead to a higher risk of accidental release, theft, or, worse, a disgruntled employee gaining access to weapons-grade pathogens. The latter scenario may well have been the case in the 2001 Amerithax attacks, so it is unusual that the authors of the report did not recommend an expansion of personnel reliability programs to all those engaged in biodefense-related research.

And while the report emphasizes the importance of improvements in biosafety, biosecurity, and fostering a culture of security awareness within the biodefense research community, it is vital that these improvements be made before any alteration to the SAP is considered. The list of biosecurity lapses that have occurred in the US in the last two years alone is extremely concerning, to say the least. One incident — the discovery of two vials of viable smallpox virus in a cold storage room at the National Institutes of Health campus in Maryland in July 2014 — was, in biosecurity terms, akin to finding the biological equivalent of a forgotten atomic bomb.

Synthetic biological threats. The report also does not focus enough on the threats posed by the still-emerging field of synthetic biology. While these threats are often overplayed, the fact remains that synthetic biology is advancing at a staggering rate, and it is of paramount importance that US biodefense strategy keeps pace with these advances. This would entail, at a very minimum, ensuring that current policies for oversight of Dual Use Research of Concern (DURC) are extended fully into the private sector where a significant proportion of synthetic biology research takes place. (Currently oversight is mandatory only in laboratories that are at least partially funded by the US government or which work with one or more of 15 listed agents or toxins.)

Oversight should also be focused on so-called “garage biology,” a growing movement of self-styled “biohackers,” conducting experiments in rudimentary laboratories outside traditional research institutions. The dangers inherent in this “do-it-yourself biology,” although minimal at the moment, will undoubtedly increase with time.

The broader impacts of biological threats. Notable by its absence in the report is any real discussion of the psychological effects of biological events. Group panic is more likely to occur during an outbreak of infectious disease than conventional terrorism or natural disasters. In fact, this is one of the key “advantages” of bioterrorism. This was witnessed in the “Ebolanoia” phenomena during the recent EVD outbreak. (The term was coined by the health journalist Maryn McKenna.) A psychologically understandable response to perceived uncontrollable and potentially catastrophic events (known as “dread risk”), when inflated by media outlets, inevitably creates overreaction among the public. This can be countered by timely, regular, and accurate communication of all relevant information to the public by trusted media figures and experts, and such communication should form part of any biodefence planning.

Also missing from the report is any discussion of overt or covert military action against biological weapons production facilities. It is perfectly conceivable that in the future, the US may have to destroy such a production facility. As such, research, development, and testing of specific weapons systems designed to do so should form an integral part of the nation’s biodefense strategy. Conventional high explosive munitions do not generate sufficient heat to destroy biological weapons; standard precision weapons would not only fail to destroy biological weapons within a production facility, but would risk releasing biological agents into the environment. As such, Agent Defeat Weapons are currently the only non-nuclear weapon class in the US arsenal capable of destroying biological weapons facilities without the risk of agent release. In tandem, the Defense Threat Reduction Agency (DTRA) should continue to focus on developing more effective and novel methods to both protect warfighters (especially Special Operations Forces) against biological threats, and to enhance their capabilities to destroy biological weapons in ground operations.

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The Blue Ribbon Panel’s report on biodefense is an outstanding work. But it could nonetheless be improved upon by incorporating the suggestions above.

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About the Author

is an Associate at Brehon Advisory and a PhD candidate at Queen's University Belfast. You can follow him on Twitter (@brownecfm).