U.S. Public Health System Needs To Acclerate Attention to Bioterror Threat

By Jonathan Winer

Regardless of whether the recent reports of terrorist experimentation with bubonic plague in Algeria prove true or false, they serve as a reminder that the U.S. remains inadequately prepared to detect quickly or respond effectively to biological attacks.

It is worth looking back at the last sustained Congressional testimony on the topic, from the departing head of the public health component of the Department of Homeland Security, Dr. Jeffery W. Runge, on July 22, 2008.

He warned that the risk of a large-scale biological attack on the U.S. remained "significant," finding that al-Qaeda continued to seek to develop and use a biological weapon to cause mass casualties in an attack on the U.S. He highlighted anthrax, not plague, as the most likely choice, and warned that a single successful urban attack could kill hundreds of thousands of people, making an aerosolized anthrax attack DHS's number one bioterrorism concern.

His three major recommendations address important needed steps. First, speeding detection through technologies that reduce the time-to-detect to allow the necessary time to deliver life-saving medical countermeasures to the population. Second, moving forward on the National Biosurveillance Integration Center (NBIC), to integrate interagency information across the sectors of human health, animal health, food, water and the environment. Third, integrating the work of DHS and our health community to build common access to information and systems that work together for security and for health.

As of July 2008, the GAO found that the NBIC was a work in progress, which appeared to have very limited existing capabilities, needing to complete its work in any number of areas. But even assuming DHS is able to get its act more fully together in this realm to speed detection and knit together resources, the question remains whether the underlying public health resources are sufficient to meet the tests a mass event may someday impose.

The findings of a December 2008 report, "Ready or Not?" issued annually by the Robert Wood Johnson Foundation project "Trust for America's Health" suggest we still have a great deal to do to be ready for any form of significant terror-generated health emergency, and that budget cuts are leading to deterioration in existing capacities, even as planning for future integration and enhancement goes forward. The report provides a detailed report card on many aspects of public health disaster planning and capabilities at both the federal and state evels, and is worth reviewing in its entirety. But one set of statistics stand out. We have slightly less than one million hospital beds in the United States, which typically run at circa 80% capacity, leaving some 200,000 beds empty on any given day. All of that changes the moment a mass public health emergency begins. For example, half of the states would not be able to generate enough bed capacity within two weeks of a moderate pandemic—that is, a pandemic with a severity midway between the severe 1918 flu outbreak and the mild flu outbreak in 1968. In a severe pandemic (like in 1918), 47 states and the District of Columbia would run out of hospital beds within two weeks. Creating large quantities of additional beds at hospitals that remain unused under normal circumstances would not seem to be the best answer -- but the absence of an alternative system to deal with the types of mass emergencies that we would face in the event of a significant bioterror attack is one we would regret if the predicted catastrophe ever becomes a reality.

The Algerian plague allegations may or may not prove that Al Qaeda is further down the road of planning a bioattack on the United States. (The posts by CT Blog contributor Olivier Guitta provide an excellent integration of relevant currently available public facts.) Regardless, it should be another wake up call that the work to be done in integrating our public and private capacities into a system that can meet our needs in emergencies must be accelerated.