Who s Ready for a Bioterrorist Attack? Preparation, Biosurveillance, and Response

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1 Christina Hunter Rance LeFebver Derek Dockter 29 July, 2012 Who s Ready for a Bioterrorist Attack? Preparation, Biosurveillance, and Response Bioterrorism is the use of biological agents, such as bacteria or other harmful microorganisms, to inflict harm on someone or something. It is a very serious and dangerous threat, and is becoming increasingly dangerous as science and technology advance. To mitigate the effect of such an attack, a country must be properly prepared, be able to watch out for potential biological threats, and must respond properly and effectively to different threats. This can be done through having the right resources, finances, communication and leadership. Terrorism refers to the use or threat of force or violence against people or property. A bioterrorist attack releases viruses, bacteria, or other germs to cause illness or death. ( Bioterrorism and Biodefense. MedlinePlus. U.S. National Library of Medicine National Institutes of Health. n.d. Web. 23 Jul. 2012). It is one of the most dangerous and most difficult threats to prepare for, yet few really acknowledge the possibility of its occurrence the US in particular. With about 5,920 miles bordering Canada and Mexico, 12,383 miles of coastline (including all US territories), and the staggering amount of foreign goods the US imports on a daily basis, it faces numerous possibilities of terrorist attacks every day. While searching for explosive material and weaponry can be challenging, the task of detecting and preventing bioterrorist attacks is even more difficult. This is due to the many different ways that the agents can be transmitted, which can be through food, water, air or even person to person, and the multiple ways they can affect living organisms. Regardless of the type of bioterrorist attack the US, or anywhere in the world, may face, there are several steps and precautions that can be 1

2 made to either prevent or properly handle a bioterrorist attack. First, however, the flaws and weaknesses of the system must be acknowledged. There are several areas that have to be taken into account when considering preparation for bioterrorist attacks. For instance, in the case of a pandemic (outbreak of a disease over a large area), a region s health care facilities must be ready to both treat and contain the victims of the illness in large quantities. There should be designated persons, trained and ready to act in case of a large scale emergency. Proper leadership and sufficient resources should always be available. The most crucial way one can hope to defend and prepare for a bioterrorist attack is through creating effective and readily available vaccinations and medications to fight against the agents. If such remedies are available before the occurrence of the attack, the outbreak and outcome of the attack shrink significantly. The US has several steps it needs to take before it is ready to effectively protect itself from a bioterrorist attack. The American health care system needs much improvement. While it may seem to be up to par now, this reality will become more easily known in the event of a mega disaster. For years, many have contemplated the possibility of an aggressive bird flu epidemic. While the Avian Influenza occurs mainly in birds and has not been found to be contagious from person to person contact, this killer bug will be able to create global mayhem once it attains the ability to spread easily from person to person, not just from bird to person ( Redlener 26). According to Redlener, this could be possible if the virus were able mesh with another highly contagious virus or if it adapted, as viruses often do. In such a case, almost immediately one would be able to identify the inefficiencies in the American health care system. As stated in Americans at Risk, already the waits in medical offices are too long, and in addition to the millions who have no health insurance, millions more live in areas where there are physician shortages and poor access to care in general (Redlener 19). In a state of pandemic, hospitals would be flooded by sick patients. Doctors and physicians would be overwhelmed, and in areas where the number of trained professionals is low, the sick would suffer. Even where there is a sufficient amount of doctors and physicians, the number of 2

3 patients would be so large that they would have to begin prioritizing patients, which will also result in many others suffering. As pointed out in Americans at Risk, local health and hospital systems need enough guidance, leadership, and financial support to respond effectively to a new outbreak of disease. Furthermore, if the resources could be found to stabilize hospitals general financial situation, their ability to develop workable plans for expanding their capacity to provide emergency care for infected and sick patients can be vastly improved ( Redlener 38 39). With more money, hospitals would stand a greater chance against large pandemics and bioterrorist attacks. Also, with good leadership, decisions can be made quickly and more effectively. Information sharing also becomes important in the event of a bioterrorist attack, between both government agencies and the general public. Since 2001, steps have been taken to improve the quality of the US information sharing system. Additional post 2001 homeland security information sharing initiatives have included the expansion of the FBI s Joint Terrorist Task Forces that bring together personnel from all governmental levels, the creation of some states and localities of their own information fusion centers, and the establishment of the DHS program to improve the protection of commercially sensitive information provided by private owners of critical assets ( Johnstone 153). However, the US still struggles with the task of information sharing. January 2007, the US Government Accountability Office reported More than 5 years after 9/11, the federal government still lacks an implemented set of policies and processes for sharing terrorism information, but has issued a government wide strategy on how it will put in place the overall framework, policies, and architecture for sharing with critical partners ( Johnstone ). Most often information is spread to the general public through radio, television, newspaper, or word of mouth. There are many technologies dedicated to keeping people connected, however communication becomes more difficult when the government is involved. It is crucial how and to whom the proper information must be spread in the event of a terrorist attack. Government agencies, the head of the nation, must be aware of all details so that they may instruct and make timely decisions. 3

4 In order to ensure the proper course of action and preparation when dealing with a bioterrorist attack, the threat of the situation is evaluated using a process called the risk assessment. Assessing risks involves identifying hazards and estimating potential losses (Gustin 118). Only when the extent of the threat is determined can one properly plan and prepare for its occurrence. Finally, when preparing for the event of a bioterrorist attack, the everyday citizen must also be aware of what he or she can do to help out. Many brush off the idea that a bioterrorist attack could happen at any moment, and for that reason a large number of citizens are even less prepared for disaster. As stated in Americans at Risk, being really prepared is much more involved and much more about mental readiness (Redlener 240). The individual must be aware of what he or she can do to prevent and defend against attacks such as these. Keeping updated on what public safety resources highly recommend, such as two weeks worth of water and plenty of canned foods, is definitely critical in preparing for disasters, but, as suggested in Americans at Risk, there are other ways everyday citizens can prepare themselves. Redlener lists Eight Principles of Citizen Preparedness, which include: staying healthy and fit, developing a citizen responder state of mind, learning basic CPR and first aid, having situational awareness and remaining cognizant of your surroundings, knowledge of the potential dangers of your community (i.e. hidden fault lines), making sure you have a good family plan, and having an emergency communications plan (Redlener ). Following the advice given by both Redlener and the U.S. Health and Human Services, one can properly prepare for any of the disasters he or she may face. Biosurveillance is the systematic monitoring of environmental conditions, biological agents, and global health situations designed to detect disease early enough to avoid catastrophic biological events (Connor, Scott The Importance of a National Biosurveillance Strategy. NACCHO. Oct Web. 27 Jul. 2012). While it is important to be prepared, it is just as important (if not more important)that a region have an adequate biosurveillance system. This fact is only emphasized as threats evolve and the world of science and technology advances. If a region could easily detect or be forewarned about a harmful biological agent, it 4

5 would be that much easier to deal with because it could always be caught in its earliest stages. Ideally, the agent could be detected before it has any effect. The US is fully aware of this. To address this issue, some federal agencies are planning or have taken actions to attract and maintain expertise using fellowships, incentives, and cooperative agreements. Moreover, CDC has called for the development of a national training and education framework to articulate professional roles and competencies necessary for biosurveillance. The Department of Agriculture has also developed training programs to help ensure that diseases and pests that could harm plants or animals can be identified. In addition, federal agencies have taken various actions designed to promote timely detection and situational awareness by developing (1) information sharing and analysis mechanisms, (2) laboratory networks to enhance diagnostic capacity, and (3) equipment and technologies to enhance early detection and situational awareness ( Efforts to Develop a National Biosurveillance Capability Need a National Strategy and a Designated Leader. U.S. GAO. 30 Jun Web. 29 Jul. 2012). There are many ways that the US can be attacked using biological weapons, and thus the US must take the necessary measures to detect and prevent bioterrorist attacks. Already it has suffered from small scale attacks, such as the Anthrax laced letters in October 2001, but with better technology attacks are bound to get more elaborate. For that reason, it is important that biosurveillance become more thorough and accurate. Critical Biologic Agents for Use in Bioterrorism Category A agents Bacillus anthracis (anthrax) Clostridium botulinum toxin (botulism) Yersinia pestis (plague) Francisella tularensis (tularemia) Variola major virus (smallpox) Ebola, Marburg, Lassa, and South American hemorrhagic fever viruses (viral hemorrhagic fever) Category B agents Coxiella burnetti (Q fever) Brucella species (brucellosis) Burkholderia mallei (glanders) Alphaviruses (Venezuelan encephalomyelitis and eastern and western equine encephalomyelitis) 5

6 Ricin toxin from Ricinus communis (castor beans) Epsilon toxin of Clostridium perfringens Staphylococcus enterotoxin B Foodborne or waterborne agents also are included under Category B. These pathogens include but are not limited to: Salmonella species Shigella species Escherichia coli O157:H7 Vibrio cholerae Cryptosporidium parvum Category C agents Nipah virus Hantaviruses Tickborne hemorrhagic fever viruses Tickborne encephalitis viruses Yellow fever virus Multidrug resistant Mycobacterium tuberculosis Source: CDC. Biological and chemical terrorism. ( History, Likely Agents, Perpetrators, and Dissemination. CIDRAP. Academic Health Center University of Minnesota. n.d. Web. 29 Jul. 2012). There are a large number of biological agents that can potentially be used for a bioterrorist attack. The most dangerous include: Bacillus anthracis (anthrax), Clostridium botulinum toxin (botulism), Yersinia pestis (plague), Francisella tularensis (tularemia), Variola major virus(smallpox), Ebola, Marburg, Lassa, and South American hemorrhagic fever viruses (viral hemorrhagic fever), which fall into Category A agents in the chart above. These agents were placed into this category for their following characteristics: they are easily disseminated(spread) or transmitted from person to person, cause high mortality, pose a potential threat to major public health, can possibly cause public panic and social disruption, and require special action for public health preparedness ( History, Likely Agents, Perpetrators, and Dissemination. CIDRAP. Academic Health Center University of Minnesota. n.d. Web. 29 Jul. 2012). The CDC categorizes different biological agents based on how easily they are spread, accessed and the severities of their affects Category A being the most dangerous. The way in which a harmful biological agent would be handled varies on the characteristics of the agent. For instance, if a clinic were dealing with a Category A agent, such 6

7 as Ebola, which has a very high mortality rate (90%) and is known to be transmitted through bodily fluids, they would have to consider treating the patient as well as containing him or her. However, treatment would be very difficult because the doctor also faces the possibility of becoming infected if he or she comes in contact with the bodily fluid. Direct contact is out of the question, and the concern is less about treating the patient than it is about containing him or her. It is important that the virus not spread. Keeping it confined will lessen the impact of the attack and minimize the number of people that will be affected by the virus. For another, less easily spread agent, such as Glanders, which can be easily disseminated but has a lower mortality rate, priorities slightly shift. The victims can now be handled, though still cautiously, and containment will not be as difficult. Neither Ebola nor Glanders have vaccines, so the best way the public can respond is through avoiding infected persons or animals. For other agents in which there are vaccines, their distribution ideally should have been taken care of in the preparation plan. Vaccinations can take on average 8 to 10 days to take effect, so they are meant to be done in advance ( How long does it take a vaccine to work? TBO.com. 12 Nov Web. 29 Jul. 2012). While the response to a bioterrorist attack would not be necessary if both a region s preparation and biosurveillance system were effective, it is important to be able to respond the right way in such an event. Preparation will play in greatly when it comes to response. With the proper equipment, communication and knowledge of an agent, it is highly possible to recover from biological attacks. Organizations and health regulations have also been established and modified for the sole purpose of countering disasters such as bioterrorist attacks. They include the World Health Organization, the IHR(International Health Regulations 2005), the National Security Council, the Homeland Security Council, the Office of the Vice President and the Department of Defense( Countering Biological Threats. The National Academic Press. n.d. Web. 29 Jul. 2012). Many have prepared detailed and elaborate response plans in case of any biological attack. 7

8 As stated just five years ago, March 2007 by bioweapons expert Dr. Tara O Toole, A covert bioterrorist attack on US citizens or, even worse, a campaign of such attacks, is within the capability of terrorist groups today and could potentially cause tens of thousands of casualties and immense social and economic disruption.., the technical barriers to building bioweapons that faced the superpowers in the 1970s have been overtaken by the rapid advancements in bioscience. There are today no significant barriers to terrorists seeking to conduct large scale bioattacks (Johnstone 35). These advancements in science and lapses in technical barriers can only have increased in the last five years. Preparation, biosurveillance, and response become all the more important as the sciences advance, for as they advance, risk also increases. However, simultaneously, our strategies, methods and technologies to counter such threats advance as well. The most recent bioterrorist event (the distribution of the anthrax letters in October 2001) opened the US eyes to bioterrorism, and now organizations such as the World Health Organization, Public Health Safety, Homeland Security and the US Government Accountability Office have been established to better prepare not only the US, but the entire world. Necessary steps have, and are being taken to counter dangerous, biological threats, and will hopefully prove to be effective when they are needed most. 8

9 Bibliography: Bioterrorism and Biodefense. MedlinePlus. U.S. National Library of Medicine National Institutes of Health. n.d. Web. 23 Jul < Connor, Scott The Importance of a National Biosurveillance Strategy. NACCHO. Oct Web. 27 Jul < ageid=159557> Countering Biological Threats. The National Academic Press. n.d. Web. 29 Jul < Efforts to Develop a National Biosurveillance Capability Need a National Strategy and a Designated Leader. U.S. GAO. 30 Jun Web. 29 Jul < Gustin, Joseph F. Bioterrorism A Guide for Facility Managers. Lilburn, Georgia: The Fairmount Press Inc., 2005 History, Likely Agents, Perpetrators, and Dissemination. CIDRAP. Academic Health Center University of Minnesota. n.d. Web. 29 Jul < How long does it take a vaccine to work? TBO.com. 12 Nov Web. 29 Jul < flu/2009/nov/12/how long does it take vaccine work ar 52952/> there a cure for ebola.html Johnstone, R. William. Bioterror Anthrax, Infuenza, and the Future of Public Health Security. Westport, Connecticut: Greenwood Publishing Group, Inc., 2008 Redlener, Irwin M.D. Americans at Risk. New York : Random House, Inc.,

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