Making the Nation Safer The Role of Science and Technology in Countering Terrorism (2002) / Chapter Skim
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3. Human and Agricultural Health Systems
3. Human and Agricultural Health Systems
Pages 65-106
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From page 65... ...
After exposure to a pathogen or toxin used as a biological weapon, physical symptoms can be delayed and prove difficult to distinguish from naturally occurring illnesses. Similarly, crops can be exposed to biological weapons in several ways at the seed stage, in the field, or after harvest.
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From page 66... ...
Recent experiences with the West Nile virus and anthrax spores in the United States, and with foot-and-mouth disease in the United Kingdom, offer practical lessons in human and agricultural outbreak detection, laboratory diagnosis, investigation, and response that might be useful in planning for future attacks involving biological terrorism (Fine and Layton, 2001~. The experience with the West Nile virus outbreak highlighted the importance of communication and coordination between responding agencies (U.S.
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From page 67... ...
population. A state-sponsored enterprise, or just a few individuals with specialized scientific skills and access to a laboratory, could easily and inexpensively produce a panoply of lethal biological weapons, although it is no trivial matter to disseminate or disperse such agents across large populations.
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From page 68... ...
Changing Research Paradigm While this report was being prepared, the National Institute for Allergy and Infectious Diseases (NIAID) released a bioterrorism research agenda for rapidly addressing the most threatening biological agents (NIAID, 2002.
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From page 69... ...
INTELLIGENCE, DETECTION, SURVEILLANCE, AND DIAGNOSIS A comprehensive approach to coping with bioterrorism must incorporate efforts to prevent the proliferation of biological weapons; methods for detecting covert biological weapons programs; strategies for deterring their use if biological weapons do proliferate; and mechanisms for protecting civilian and military populations if deterrence fails. The emphasis in this multitiered approach should be on defense, simply because the proliferation of biological weapons is difficult to control (biotechnology equipment and expertise are now available globally)
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From page 70... ...
of ways to deter biological attacks, the S&T community has yet to fully explore means for strengthening deterrence. An obvious option is biological forensics (discussed later)
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From page 71... ...
of bioagents have not been widely evaluated or well validated in real-world settings. Much greater attention must therefore be given to the transition between basic laboratory research and field application.
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From page 72... ...
A further challenge is the need for highly sensitive systems, as some highly infectious pathogens require the inhalation of only 1 to 10 organisms to cause disease. In general, much greater attention is needed to translate basic laboratory research into field applications and clinical validation (standards will play an important role; see Recommendation 3.16 and surrounding discussion)
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From page 73... ...
Surveillance and Diagnosis of Infection and Disease Early diagnosis of patients infected with potential biological warfare (BOO) agents is complicated by the lack of relevant medical experience with most of these agents in the United States and by the nonspecific symptoms of their associated diseases (e.g., many cause finlike symptoms in the early stages)
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From page 74... ...
Human Disease Surveillance and Diagnosis In this country and elsewhere, the recognition of almost all emerging infectious diseases both naturally occurring and intentional has depended on an astute clinician contacting a public health agency after suspecting an unusual serious illness (e.g., hantavirus in the Southwest or anthrax in Florida)
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From page 75... ...
disease outbreaks, but it is not clear whether it will be useful for early detection of key threat agents such as smallpox, anthrax, and tularemia. Because infectious diseases do not respect national borders, international cooperation is vital in the sharing of epidemiological and clinical data, both on emerging infectious diseases and on outbreaks caused by potential bioterror agents.
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From page 76... ...
could be dual use: Not only would it enhance public health by providing more accurate and timely information about the emergence of novel influenza strains, but it could also provide surge capacity to detect other agents if outbreaks occurred as a result of a terrorist attack. Continued development of effective networks of such referral laboratories (private, academic, local, state, and federal)
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From page 77... ...
, as currently constituted, has proven adequate for naturally occurring disease, it would probably be unable to help eradicate intentional introduction, especially if this were done at multiple sites. There is a need for USDA to develop a research and surveillance capability for plant and animal diseases comparable to the one that CDC oversees for human diseases.
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From page 78... ...
for any given crop, there are several pathogens that are not yet found in the United States but that cause major losses elsewhere; and (6) the biological agents that could affect crops are more numerous than the pathogens that affect humans, making it more difficult to focus the research funding available for efforts to counter agricultural bioterrorism.
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From page 79... ...
For animal disease, USDA operates several laboratories Plum Island and Ames among them that perform diagnoses, carry out research, and provide training for veterinarians. CDC is the central agency for the control and prevention of communicable human disease, but no center currently exists to serve the same function for plant disease.
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From page 80... ...
Uncertain Understanding of the Effects of Biological Weapons Modeling the likely outcomes of different bioterrorism attacks is important for two reasons. It provides insight into the severity of the threat posed by the proliferation of biological weapons, and it allows one to estimate the effectiveness of different defensive responses (and hence the priority one should assign to each)
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From page 81... ...
Such modeling may resolve many of the uncertainties about the effects of biological weapons. Substantial uncertainties regarding mechanisms of pathogenesis would still remain, however; the only way to resolve them is through new experiments that involve virulent organisms and animal models of human disease.
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From page 82... ...
Careful oversight of experiments with pathogenic organisms is essential to ensure that they are not in violation of the Biological Weapons Convention of 1972.3 Recommendation 3.7: Expand investigations into the pathogenesis of infectious agents. Review the state of knowledge on the mechanisms of pathogenesis of all bioterrorist agents and of host responses to them, and initiate an action plan to conduct laboratory research using the latest molecular biology tools.
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From page 83... ...
, and the feasibility of using tagged organisms should be comprehensively investigated to determine their value in the characterization and comparison of the biological agents used in different weapons. Many in the biological warfare defense community believe that it should be possible to use a combination of DNA sequence information (occurring naturally)
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From page 84... ...
An Approach to Defining Bioterrorist Threats Pathogenic microorganisms and the toxins produced by living organisms pose a threat to national security whether they occur in their natural state or are released in bioterrorism attacks. In either case, the greatest threats to human health in the United States come from emerging and reemerging infectious agents that sporadically occur in nature.
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From page 85... ...
Developing Antimicrobials and Antivirals The diversity of existing biological weapons and the ever-increasing number of possibilities through use of genetic recombination preclude simple therapeutic countermeasures to bioterrorism. The Soviets are known to have developed at least 30 biological agents.
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From page 86... ...
While smallpox vaccination is effective, it elicits dangerous and potentially lethal complications in a number of individuals, and because it is a live-attenuated vaccine, it poses a significant risk for all immunocompromised individuals. The limited antibiotic armamentarium is an even greater concern with respect to future threats, especially in light of an increase in the number of new and reemerging infectious diseases and a marked rise in resistance to existing antibiotics.
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From page 87... ...
Before that need is upon us, we should act now to tackle several challenges to overcome the critical shortfall of research in vaccinology: . The genome sequences of all plausible organisms that could potentially be used in a bioterrorism attack, including naturally occurring variants, need to be determined.
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From page 88... ...
to streamline vaccine deployment, even if only at times when a certain high threshold of infection or mortality had been surpassed? · Vaccines must be produced and stored in multiple secure locations, as the vaccine itself could be a target in a terrorist attack to disable our ability to respond.
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From page 89... ...
Also, there is no uniform testing standard for some of this equipment. In particular, testing is needed for antipathogen devices in order to distinguish personal protective equipment that is truly protective from items that generate a false sense of security (and that could increase people's risks by unknowingly putting them in harm's way)
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From page 90... ...
Recommendation 3.10: Improve environmental and personal protective equipment. Agencies such as EPA, NIOSH, CDC, DOD, and DOE should perform and support research on new technologies that increase the protection factors of such equipment, and ensure uniform testing oversight to certify efficacy.
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From page 91... ...
The Metropolitan Medical Response System emphasizes enhancement of local planning and response capabilities, as well as that of local hospital capacities, tailored to each jurisdiction so that it can best apply local resources to care for victims of a terrorist incident involving a weapon of mass destruction. The resulting systems are characterized by a concept of operations; specially trained responders; a special stockpile of pharmaceuticals; equipment for the detection of biological, chemical, and nuclear agents along with personal protective equip
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From page 92... ...
Microbiology laboratories are the first lines of defense for the detection of new cases of antibiotic resistance, outbreaks of food-borne infection, and a possible bioterrorism event. Maintaining high-quality clinical microbiology laboratories on site or near the institutions and communities that they serve is the best approach at present for managing infectious diseases and detecting resistance to antimicrobial agents.
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From page 93... ...
As part of a broader planning process, create a reserve system of veterinarians and plant pathologists (modeled on the military reserve system) , and prepare local and regional laboratories for deploying surge capacity to supplement and enhance disaster-response capabilities.
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From page 94... ...
However, it is essential that all federal agencies involved in response develop, through a panel of outside experts, a plan for analyzing data, developing a response, coordinating the response with other agencies and the Office of Homeland Security, and communicating with the public. Development of Treatment Protocols In most cases, there is insufficient research and information on which to base a sound public health protocol and medical response in the event of a biological attack.
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From page 95... ...
Moreover, the correct means for identifying the presence of many biological agents are not known, nor is the significance of the presence of biological agents in the natural environment (e.g., anthrax spores are found in the soil in some parts of the United States)
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From page 96... ...
POLICY AND IMPLEMENTATION Effective preparedness for countering bioterrorism will not only require focused and sustained efforts to build the nation's public and agricultural health infrastructures (including the training of health care professionals in detection, surveillance, prevention, and response) ; it will also require substantial changes in the way government-supported research is executed.
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From page 97... ...
As a companion to this initiative, a mechanism for rapid funding should be established for bioterrorism-related research conducted extramurally; this mechanism would select for creative ideas quickly, with a minimum of bureaucracy. Need for Standards and Standardization The goals for research on surveillance and clinical diagnostics include rapid diagnostic assays for common pathogens and biological warfare agents.
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From page 98... ...
It is to be expected that many new products will be introduced for detecting and responding to bioterrorist threats, but no mechanism currently exists for evaluating them and comparing their effectiveness. An oversight standards laboratory would have the capacity to evaluate biosensors and diagnostic systems for infectious diseases, develop taxonomies of syndromes and data classifications, improve the quality of the expanding DNA and protein databases, validate methods, develop reagents, create internal standards for diagnostic comparisons for the scientific community, and evaluate methods and standards for personal protective equipment and decontamination.
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From page 99... ...
But given the current needs related to antibiotic resistance in naturally occurring pathogens and to the decline of innovation in antibiotic-drug discovery, risk sharing may need to be considered more broadly. Government could further reduce the risk to industry by providing some form of legal relief from the product-liability issues associated with new countermeasures.
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From page 100... ...
For development of broad-spectrum antibiotics and antivirals, federal funding should encourage the large pharmaceutical and biotechnology companies to enter the field with the expectation that at least some drugs developed for bioterrorist threats will have dual use that is, they may be applicable to common infectious diseases as well. Such encouragement for undertaking R&D on new drugs against bioterrorism agents could take the form of streamlined grant mechanisms, financial incentives, and regulatory changes.
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From page 101... ...
Human diseases caused by many of the CDC Category A agents are so poorly understood at present that meaningfully defining such criteria for the Animal Rule will be difficult. For some agents for example, smallpox appropriate animal models are lacking, and many existing animal models are poorly characterized with respect to lesion character and disease progression.
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From page 102... ...
Although there are gaps in the scientific understanding of many potentially deadly biological agents and in the technological advances needed to anticipate and respond to their release, reliance on purely scientific or technological solutions is misguided. A much more inclusive effort is needed to build a seamless system of preparedness and response one that can exercise the best available tools to counter biological threats.
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From page 103... ...
32~. Thus, preparedness is essential not only for countering bioterrorism but also for facing the constantly evolving threat of infectious diseases, particularly the widespread escalation of bacterial pathogens resistant to all known antibiotics.
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From page 104... ...
2001. "The Application of Mathematical Models in Infectious Disease Research," Firepower in the Lab: Automation in the Fight Against Infectious Diseases and Bioterrorism, S.P.
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From page 105... ...
2001. "Lessons from the West Nile Viral Encephalitis Outbreak in New York City, 1999: Implications for Bioterrorism Preparedness," Clinical Infectious Diseases, Vol.
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From page 106... ...
2000. West Nile Virus Outbreak: Lessons for Public Health Preparedness, HEHS-00-180, Washington, D.C.
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