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Flu crisis exposes large gaps in bioterrorism readiness

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Chicago Tribune


WASHINGTON - Problems producing flu vaccines that raised the specter of a health crisis have highlighted the difficulties facing the U.S. government as it tries to counter terrorists who would attack America with bioweapons.

If terrorists were to strike with deadly biowar agents such as anthrax or plague bacteria, experts fear the nation would be hugely vulnerable, despite the billions of dollars already spent to increase national readiness after the Sept. 11 hijacking attacks and subsequent anthrax-laced letters in 2001.

The U.S. is substantially ahead of where it was three years ago, when the nation was mostly unprepared for such attacks, experts say. But further progress is urgently needed, they say, as terrorists such as al-Qaida are known to be interested in using bioweapons.

"I do think a lot has been accomplished considering where we were a couple of years ago but there's still a long, long way to go," said Dr. Charles Bailey, executive director of the National Center for Biodefense at George Mason University in Fairfax, Va.

The gaps are worrisome to experts like Bailey, former commander of the U.S. Army Medical Research Institute of Infectious Diseases at Fort Detrick, Md., one of the nation's few facilities equipped to study the deadliest microbes.

As proved by the unsolved 2001 anthrax attacks, in which envelopes containing weapons-grade spores were sent through the mail and killed five people, even crude bioterrorism attacks can be effective.

"It's not rocket science to generate these agents and disseminate them," Bailey said. "Some of these terrorist groups are believed to be capable of doing that. I'm very concerned about it.

"As the biological sciences keep progressing in its technology and know-how, it's going to become even easier for lesser-trained individuals," he added.

Not surprisingly, much of the progress since Sept. 11, 2001, has been to solve the easiest-to-tackle problems.

For instance, the nation's public health network had long been neglected, treated by politicians and the medical community as an unglamorous backwater. Many state and municipal offices lacked adequate computer and communications technologies.

"We had health departments with rotary phones and without beepers," said Dr. Georges Benjamin, executive director of the American Public Health Association, which advocates providing more resources for the nation's public health system.

Benjamin recalled that when the anthrax attacks occurred and he was Maryland's top health officer, "our capacity to pull all the state health officials in the country on the phone at one time was zero. We didn't even have the numbers." That has been fixed as public health officials reached out to one another.

Considered just as important is a changed mindset among public health workers.

"Our index of suspicion is much higher," Benjamin said. "We're more likely to think something might be intentional where we would've never thought it was intentional before."

For instance, if doctors saw several patients come into a hospital emergency room with flulike symptoms outside the flu season "we're more likely to think that's intentional and rule that out first," he said.

But more difficult problems persist. There is still a relative lack of vaccines to prevent outbreaks caused by microbes that experts worry most about and drugs to treat those infected. There is no effective vaccine for some pathogens, for instance.

It is a problem likely to take years to fix due to lengthy lead times necessary to develop effective vaccines and treatments. But the pharmaceutical industry has also not rushed to make the needed products because it is not clear that companies could recuperate their costs and make a profit, experts said.

Those difficulties were recently underscored with the shortage of influenza vaccine for this flu season, which led to long lines of people hoping to get the scarce shots and congressional inquiries. Earlier this year, President Bush enacted Bioshield legislation, aimed at providing billions of dollars in incentives for drug companies to develop products that could protect Americans against bioterrorism attacks.

But a recent survey of experts in the field found the government's efforts will not "produce the countermeasures the nation needs for a truly effective biodefense."

The review was conducted by researchers at Sarnoff Corp., a technology and consulting company based in Princeton, N.J., and at the Center for Biosecurity of the University of Pittsburgh Medical Center.

A related problem is the lack of a way to quickly diagnose people infected with the most serious pathogens. "For any of the category A agents (such as anthrax) we currently don't have any rapid clinical diagnostic test," said Michael Mair, a senior research analyst with the Center for Biosecurity.

"That makes it difficult in the event of an outbreak to identify people who've been exposed who might get sick," he said. "Especially if we have a shortage of countermeasures, it's hard to know how best to use those because we can't tell quickly who's been exposed and who hasn't, who's sick and who isn't."

Despite preparedness efforts, he said that a major bioterrorism attack infecting hundreds or thousands would quickly overwhelm health-care providers in most regions.

"We still lack the surge capacity to deal with large numbers of patients," Mair said.

Hospitals do not have the spare beds and are unlikely to get them at a time when the federal government and insurance companies are squeezing health-care institutions to keep their costs down, he said.

While homeland security dollars have flowed to assist state and local readiness, momentum has been slowed by those same governments, which in some instances laid off public health workers as part of budget-cutting measures.

But as a longtime emergency room physician, Benjamin takes a philosophical view: "You're always trying to catch up in these things. The goal is to try to shorten your response time for unanticipated events and try to mitigate some of the bad things that can happen. That's the drill."


(c) 2004, Chicago Tribune. Distributed by Knight Ridder/Tribune News Service.


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